Surgical tool end effectors with distal wedge slot constraint

ABSTRACT

A robotic surgical tool an elongate shaft, an end effector arranged at a distal end of the shaft and including opposing first and second jaws, and an articulable wrist interposing the end effector and the distal end of the shaft. The wrist includes a linkage mounted to the first and second jaws and defining a slot, a distal wedge positioned within a central portion of the wrist and providing a channel, and an alignment arm interposing the linkage and the distal wedge and providing an alignment head receivable within the slot and a projection receivable within the channel. The alignment head is translatable within the slot and the projection is translatable within the channel during operation of the end effector.

TECHNICAL FIELD

The systems and methods disclosed herein are directed to roboticsurgical tools and, more particularly to, surgical tool end effectorsthat provide distal wedge slot constraint that limits unwanted jawrotations with respect to a distal articulation joint, and therebyreduces jaw backlash.

BACKGROUND

Minimally invasive surgical (MIS) instruments are often preferred overtraditional open surgical devices due to the reduced post-operativerecovery time and minimal scarring. The most common MIS procedure may beendoscopy, and the most common form of endoscopy is laparoscopy, inwhich one or more small incisions are formed in the abdomen of a patientand a trocar is inserted through the incision to form a pathway thatprovides access to the abdominal cavity. The cannula and sealing systemof the trocar are used to introduce various instruments and tools intothe abdominal cavity, as well as to provide insufflation to elevate theabdominal wall above the organs. The instruments can be used to engageand/or treat tissue in a number of ways to achieve a diagnostic ortherapeutic effect.

Various robotic systems have recently been developed to assist in MISprocedures. Robotic systems can allow for more instinctive handmovements by maintaining natural eye-hand axis. Robotic systems can alsoallow for more degrees of freedom in movement by including anarticulable “wrist” joint that creates a more natural hand-likearticulation. In such systems, an end effector positioned at the distalend of the instrument can be articulated (moved) using a cable drivenmotion system having one or more drive cables (or other elongatemembers) that extend through the wrist joint. A user (e.g., a surgeon)is able to remotely operate the end effector by grasping andmanipulating in space one or more controllers that communicate with atool driver coupled to the surgical instrument. User inputs areprocessed by a computer system incorporated into the robotic surgicalsystem, and the tool driver responds by actuating the cable drivenmotion system and thereby actively controlling the tension balance inthe drive cables. Moving the drive cables articulates the end effectorto desired angular positions and configurations.

Improvements to robotically-enabled medical systems will providephysicians with the ability to perform endoscopic and laparoscopicprocedures more effectively and with improved ease.

BRIEF DESCRIPTION OF THE DRAWINGS

The disclosed aspects will hereinafter be described in conjunction withthe appended drawings, provided to illustrate and not to limit thedisclosed aspects, wherein like designations denote like elements.

FIG. 1 illustrates an embodiment of a cart-based robotic system arrangedfor diagnostic and/or therapeutic bronchoscopy procedure(s).

FIG. 2 depicts further aspects of the robotic system of FIG. 1 .

FIG. 3A illustrates an embodiment of the robotic system of FIG. 1arranged for ureteroscopy.

FIG. 3B illustrates an embodiment of the robotic system of FIG. 1arranged for a vascular procedure.

FIG. 4 illustrates an embodiment of a table-based robotic systemarranged for a bronchoscopy procedure.

FIG. 5 provides an alternative view of the robotic system of FIG. 4 .

FIG. 6 illustrates an example system configured to stow robotic arm(s).

FIG. 7A illustrates an embodiment of a table-based robotic systemconfigured for a ureteroscopy procedure.

FIG. 7B illustrates an embodiment of a table-based robotic systemconfigured for a laparoscopic procedure.

FIG. 7C illustrates an embodiment of the table-based robotic system ofFIG. 4 -7B with pitch or tilt adjustment.

FIG. 8 provides a detailed illustration of the interface between thetable and the column of the table-based robotic system of FIGS. 4-7 .

FIG. 9A illustrates an alternative embodiment of a table-based roboticsystem.

FIG. 9B illustrates an end view of the table-based robotic system ofFIG. 9A.

FIG. 9C illustrates an end view of a table-based robotic system withrobotic arms attached thereto.

FIG. 10 illustrates an exemplary instrument driver.

FIG. 11 illustrates an exemplary medical instrument with a pairedinstrument driver.

FIG. 12 illustrates an alternative design for an instrument driver andinstrument where the axes of the drive units are parallel to the axis ofthe elongated shaft of the instrument.

FIG. 13 illustrates an instrument having an instrument-based insertionarchitecture.

FIG. 14 illustrates an exemplary controller.

FIG. 15 depicts a block diagram illustrating a localization system thatestimates a location of one or more elements of the robotic systems ofFIG. 1 -7C, such as the location of the instrument of FIGS. 11-13 , inaccordance to an example embodiment.

FIG. 16 is an isometric side view of an example surgical tool that mayincorporate some or all of the principles of the present disclosure.

FIG. 17 depicts separated isometric end views of the instrument driverand the surgical tool of FIG. 16 .

FIG. 18 is an enlarged isometric view of the distal end of the surgicaltool of FIGS. 16 and 17 , according to one or more embodiments.

FIGS. 19A and 19B are isometric, partially exploded views of the endeffector of FIG. 18 from right and left vantage points, respectively,according to one or more embodiments.

FIGS. 20A and 20B are additional isometric, partially exploded views ofthe end effector of FIG. 18 from the right and left vantage points.

FIGS. 21A and 21B are additional isometric, partially exploded views ofthe end effector of FIG. 18 from the right and left vantage points.

FIG. 22 is an enlarged, partial cross-sectional side view of the endeffector, according to one or more embodiments.

FIG. 23 is another enlarged, partial cross-sectional side view of theend effector, according to one or more embodiments.

DETAILED DESCRIPTION Overview

Aspects of the present disclosure may be integrated into arobotically-enabled medical system capable of performing a variety ofmedical procedures, including both minimally invasive (e.g.,laparoscopy) and non-invasive (e.g., endoscopy) procedures. Amongendoscopy procedures, the system may be capable of performingbronchoscopy, ureteroscopy, gastroscopy, etc.

In addition to performing the breadth of procedures, the system mayprovide additional benefits, such as enhanced imaging and guidance, toassist the physician. Additionally, the system may provide the physicianwith the ability to perform the procedure from an ergonomic positionwithout the need for awkward arm motions and positions. Still further,the system may provide the physician with the ability to perform theprocedure with improved ease of use such that one or more of theinstruments of the system can be controlled by a single user.

Various embodiments will be described below in conjunction with thedrawings for purposes of illustration. It should be appreciated thatmany other implementations of the disclosed concepts are possible, andvarious advantages can be achieved with the disclosed implementations.Headings are included herein for reference and to aid in locatingvarious sections. These headings are not intended to limit the scope ofthe concepts described with respect thereto, as such concepts may haveapplicability throughout the entire specification.

A Robotic System Cart.

The robotically-enabled medical system may be configured in a variety ofways depending on the particular procedure. FIG. 1 illustrates anembodiment of a cart-based robotically-enabled system 100 arranged for adiagnostic and/or therapeutic bronchoscopy procedure. For a bronchoscopyprocedure, the robotic system 100 may include a cart 102 having one ormore robotic arms 104 (three shown) to deliver a medical instrument(alternately referred to as a “surgical tool”), such as a steerableendoscope 106 (e.g., a procedure-specific bronchoscope forbronchoscopy), to a natural orifice access point (i.e., the mouth of thepatient) to deliver diagnostic and/or therapeutic tools. As shown, thecart 102 may be positioned proximate to the patient’s upper torso inorder to provide access to the access point. Similarly, the robotic arms104 may be actuated to position the bronchoscope relative to the accesspoint. The arrangement in FIG. 1 may also be utilized when performing agastro-intestinal (GI) procedure with a gastroscope, a specializedendoscope for GI procedures.

Once the cart 102 is properly positioned adjacent the patient, therobotic arms 104 are operated to insert the steerable endoscope 106 intothe patient robotically, manually, or a combination thereof. Thesteerable endoscope 106 may comprise at least two telescoping parts,such as an inner leader portion and an outer sheath portion, where eachportion is coupled to a separate instrument driver of a set ofinstrument drivers 108. As illustrated, each instrument driver 108 iscoupled to the distal end of a corresponding one of the robotic arms104. This linear arrangement of the instrument drivers 108, whichfacilitates coaxially aligning the leader portion with the sheathportion, creates a “virtual rail” 110 that may be repositioned in spaceby manipulating the robotic arms 104 into different angles and/orpositions. Translation of the instrument drivers 108 along the virtualrail 110 telescopes the inner leader portion relative to the outersheath portion, thus effectively advancing or retracting the endoscope106 relative to the patient.

As illustrated, the virtual rail 110 (and other virtual rails describedherein) is depicted in the drawings using dashed lines, thus notconstituting any physical structure of the system 100. The angle of thevirtual rail 110 may be adjusted, translated, and pivoted based onclinical application or physician preference. For example, inbronchoscopy, the angle and position of the virtual rail 110 as shownrepresents a compromise between providing physician access to theendoscope 106 while minimizing friction that results from bending theendoscope 106 into the patient’s mouth.

After insertion into the patient’s mouth, the endoscope 106 may bedirected down the patient’s trachea and lungs using precise commandsfrom the robotic system 100 until reaching a target destination oroperative site. In order to enhance navigation through the patient’slung network and/or reach the desired target, the endoscope 106 may bemanipulated to telescopically extend the inner leader portion from theouter sheath portion to obtain enhanced articulation and greater bendradius. The use of separate instrument drivers 108 also allows theleader portion and sheath portion to be driven independent of eachother.

For example, the endoscope 106 may be directed to deliver a biopsyneedle to a target, such as, for example, a lesion or nodule within thelungs of a patient. The needle may be deployed down a working channelthat runs the length of the endoscope 106 to obtain a tissue sample tobe analyzed by a pathologist. Depending on the pathology results,additional tools may be deployed down the working channel of theendoscope for additional biopsies. After identifying a tissue sample tobe malignant, the endoscope 106 may endoscopically deliver tools toresect the potentially cancerous tissue. In some instances, diagnosticand therapeutic treatments can be delivered in separate procedures. Inthose circumstances, the endoscope 106 may also be used to deliver afiducial marker to “mark” the location of a target nodule as well. Inother instances, diagnostic and therapeutic treatments may be deliveredduring the same procedure.

The system 100 may also include a movable tower 112, which may beconnected via support cables to the cart 102 to provide support forcontrols, electronics, fluidics, optics, sensors, and/or power to thecart 102. Placing such functionality in the tower 112 allows for asmaller form factor cart 102 that may be more easily adjusted and/orrepositioned by an operating physician and his/her staff. Additionally,the division of functionality between the cart / table and the supporttower 112 reduces operating room clutter and facilitates improvingclinical workflow. While the cart 102 may be positioned close to thepatient, the tower 112 may alternatively be stowed in a remote locationto stay out of the way during a procedure.

In support of the robotic systems described above, the tower 112 mayinclude component(s) of a computer-based control system that storescomputer program instructions, for example, within a non-transitorycomputer-readable storage medium such as a persistent magnetic storagedrive, solid state drive, etc. The execution of those instructions,whether the execution occurs in the tower 112 or the cart 102, maycontrol the entire system or sub-system(s) thereof. For example, whenexecuted by a processor of the computer system, the instructions maycause the components of the robotics system to actuate the relevantcarriages and arm mounts, actuate the robotics arms, and control themedical instruments. For example, in response to receiving the controlsignal, motors in the joints of the robotic arms 104 may position thearms into a certain posture or angular orientation.

The tower 112 may also include one or more of a pump, flow meter, valvecontrol, and/or fluid access in order to provide controlled irrigationand aspiration capabilities to the system 100 that may be deployedthrough the endoscope 106. These components may also be controlled usingthe computer system of the tower 112. In some embodiments, irrigationand aspiration capabilities may be delivered directly to the endoscope106 through separate cable(s).

The tower 112 may include a voltage and surge protector designed toprovide filtered and protected electrical power to the cart 102, therebyavoiding placement of a power transformer and other auxiliary powercomponents in the cart 102, resulting in a smaller, more moveable cart102.

The tower 112 may also include support equipment for sensors deployedthroughout the robotic system 100. For example, the tower 112 mayinclude opto-electronics equipment for detecting, receiving, andprocessing data received from optical sensors or cameras throughout therobotic system 100. In combination with the control system, suchopto-electronics equipment may be used to generate real-time images fordisplay in any number of consoles deployed throughout the system,including in the tower 112. Similarly, the tower 112 may also include anelectronic subsystem for receiving and processing signals received fromdeployed electromagnetic (EM) sensors. The tower 112 may also be used tohouse and position an EM field generator for detection by EM sensors inor on the medical instrument.

The tower 112 may also include a console 114 in addition to otherconsoles available in the rest of the system, e.g., a console mounted tothe cart 102. The console 114 may include a user interface and a displayscreen (e.g., a touchscreen) for the physician operator. Consoles in thesystem 100 are generally designed to provide both robotic controls aswell as pre-operative and real-time information of the procedure, suchas navigational and localization information of the endoscope 106. Whenthe console 114 is not the only console available to the physician, itmay be used by a second operator, such as a nurse, to monitor the healthor vitals of the patient and the operation of system, as well as provideprocedure-specific data, such as navigational and localizationinformation. In other embodiments, the console 114 may be housed in abody separate from the tower 112.

The tower 112 may be coupled to the cart 102 and endoscope 106 throughone or more cables 116 connections. In some embodiments, supportfunctionality from the tower 112 may be provided through a single cable116 extending to the cart 102, thus simplifying and de-cluttering theoperating room. In other embodiments, specific functionality may becoupled in separate cabling and connections. For example, while powermay be provided through a single power cable to the cart 102, supportfor controls, optics, fluidics, and/or navigation may be providedthrough one or more separate cables.

FIG. 2 provides a detailed illustration of an embodiment of the cart 102from the cart-based robotically-enabled system 100 of FIG. 1 . The cart102 generally includes an elongated support structure 202 (also referredto as a “column”), a cart base 204, and a console 206 at the top of thecolumn 202. The column 202 may include one or more carriages, such as acarriage 208 (alternatively “arm support”) for supporting the deploymentof the robotic arms 104. The carriage 208 may include individuallyconfigurable arm mounts that rotate along a perpendicular axis to adjustthe base 214 of the robotic arms 104 for better positioning relative tothe patient. The carriage 208 also includes a carriage interface 210that allows the carriage 208 to vertically translate along the column202.

The carriage interface 210 is connected to the column 202 through slots,such as slot 212, that are positioned on opposite sides of the column202 to guide the vertical translation of the carriage 208. The slot 212contains a vertical translation interface to position and hold thecarriage 208 at various vertical heights relative to the cart base 204.Vertical translation of the carriage 208 allows the cart 102 to adjustthe reach of the robotic arms 104 to meet a variety of table heights,patient sizes, and physician preferences. Similarly, the individuallyconfigurable arm mounts on the carriage 208 allow a base 214 of therobotic arms 104 to be angled in a variety of configurations.

In some embodiments, the slot 212 may be supplemented with slot covers(not shown) that are flush and parallel to the slot surface to preventdirt and fluid ingress into the internal chambers of the column 202 andthe vertical translation interface as the carriage 208 verticallytranslates. The slot covers may be deployed through pairs of springspools positioned near the vertical top and bottom of the slot 212. Thecovers are coiled within the spools until deployed to extend and retractfrom their coiled state as the carriage 208 vertically translates up anddown. The spring-loading of the spools provides force to retract thecover into a spool when carriage 208 translates towards the spool, whilealso maintaining a tight seal when the carriage 208 translates away fromthe spool. The covers may be connected to the carriage 208 using, forexample, brackets in the carriage interface 210 to ensure properextension and retraction of the cover as the carriage 208 translates.

The column 202 may internally comprise mechanisms, such as gears andmotors, which are designed to use a vertically aligned lead screw totranslate the carriage 208 in a mechanized fashion in response tocontrol signals generated in response to user inputs, e.g., inputs fromthe console 206.

The robotic arms 104 may generally comprise robotic arm bases 214 andend effectors 216 (three shown), separated by a series of linkages 218connected by a corresponding series of joints 220, each joint 220including an independent actuator, and each actuator including anindependently controllable motor. Each independently controllable joint220 represents an independent degree of freedom available to thecorresponding robotic arm 104. In the illustrated embodiment, each arm104 has seven joints 220, thus providing seven degrees of freedom. Amultitude of joints 220 result in a multitude of degrees of freedom,allowing for “redundant” degrees of freedom. Redundant degrees offreedom allow the robotic arms 104 to position their respective endeffectors 216 at a specific position, orientation, and trajectory inspace using different linkage positions and joint angles. This allowsfor the system 100 to position and direct a medical instrument from adesired point in space while allowing the physician to move the armjoints 220 into a clinically advantageous position away from the patientto create greater access, while avoiding arm collisions.

The cart base 204 balances the weight of the column 202, the carriage208, and the arms 104 over the floor. Accordingly, the cart base 204houses heavier components, such as electronics, motors, power supply, aswell as components that either enable movement and/or immobilize thecart. For example, the cart base 204 includes rolling casters 222 thatallow for the cart to easily move around the room prior to a procedure.After reaching an appropriate position, the casters 222 may beimmobilized using wheel locks to hold the cart 102 in place during theprocedure.

Positioned at the vertical end of the column 202, the console 206 allowsfor both a user interface for receiving user input and a display screen(or a dual-purpose device such as, for example, a touchscreen 224) toprovide the physician user with both pre-operative and intra-operativedata. Potential pre-operative data on the touchscreen 224 may includepre-operative plans, navigation and mapping data derived frompre-operative computerized tomography (CT) scans, and/or notes frompre-operative patient interviews. Intra-operative data on thetouchscreen 224 may include optical information provided from the tool,sensor and coordinate information from sensors, as well as vital patientstatistics, such as respiration, heart rate, and/or pulse. The console206 may be positioned and tilted to allow a physician to access theconsole from the side of the column 202 opposite carriage 208. From thisposition, the physician may view the console 206, the robotic arms 104,and the patient while operating the console 206 from behind the cart102. As shown, the console 206 also includes a handle 226 to assist withmaneuvering and stabilizing cart 102.

FIG. 3A illustrates an embodiment of the system 100 of FIG. 1 arrangedfor ureteroscopy. In a ureteroscopic procedure, the cart 102 may bepositioned to deliver a ureteroscope 302, a procedure-specific endoscopedesigned to traverse a patient’s urethra and ureter, to the lowerabdominal area of the patient. In ureteroscopy, it may be desirable forthe ureteroscope 302 to be directly aligned with the patient’s urethrato reduce friction and forces on the sensitive anatomy. As shown, thecart 102 may be aligned at the foot of the table to allow the roboticarms 104 to position the ureteroscope 302 for direct linear access tothe patient’s urethra. From the foot of the table, the robotic arms 104may insert the ureteroscope 302 along a virtual rail 304 directly intothe patient’s lower abdomen through the urethra.

After insertion into the urethra, using similar control techniques as inbronchoscopy, the ureteroscope 302 may be navigated into the bladder,ureters, and/or kidneys for diagnostic and/or therapeutic applications.For example, the ureteroscope 302 may be directed into the ureter andkidneys to break up kidney stone build-up using a laser or ultrasoniclithotripsy device deployed down a working channel of the ureteroscope302. After lithotripsy is complete, the resulting stone fragments may beremoved using baskets deployed down the working channel of theureteroscope 302.

FIG. 3B illustrates another embodiment of the system 100 of FIG. 1arranged for a vascular procedure. In a vascular procedure, the system100 may be configured such that the cart 102 may deliver a medicalinstrument 306, such as a steerable catheter, to an access point in thefemoral artery in the patient’s leg. The femoral artery presents both alarger diameter for navigation as well as a relatively less circuitousand tortuous path to the patient’s heart, which simplifies navigation.As in a ureteroscopic procedure, the cart 102 may be positioned towardsthe patient’s legs and lower abdomen to allow the robotic arms 104 toprovide a virtual rail 308 with direct linear access to the femoralartery access point in the patient’s thigh / hip region. After insertioninto the artery, the medical instrument 306 may be directed and advancedby translating the instrument drivers 108. Alternatively, the cart 102may be positioned around the patient’s upper abdomen in order to reachalternative vascular access points, such as, for example, the carotidand brachial arteries near the patient’s shoulder and wrist.

B Robotic System Table.

Embodiments of the robotically-enabled medical system may alsoincorporate the patient’s table. Incorporation of the table reduces theamount of capital equipment within the operating room by removing thecart, which allows greater access to the patient. FIG. 4 illustrates anembodiment of such a robotically-enabled system 400 arranged for abronchoscopy procedure. As illustrated, the system 400 includes asupport structure or column 402 for supporting platform 404 (shown as a“table” or “bed”) over the floor. Much like in the cart-based systems,the end effectors of the robotic arms 406 of the system 400 compriseinstrument drivers 408 that are designed to manipulate an elongatedmedical instrument, such as a bronchoscope 410, through or along avirtual rail 412 formed from the linear alignment of the instrumentdrivers 408. In practice, a C-arm for providing fluoroscopic imaging maybe positioned over the patient’s upper abdominal area by placing theemitter and detector around the table 404.

FIG. 5 provides an alternative view of the system 400 without thepatient and medical instrument for discussion purposes. As shown, thecolumn 402 may include one or more carriages 502 shown as ring-shaped inthe system 400, from which the one or more robotic arms 406 may bebased. The carriages 502 may translate along a vertical column interface504 that runs the length (height) of the column 402 to provide differentvantage points from which the robotic arms 406 may be positioned toreach the patient. The carriage(s) 502 may rotate around the column 402using a mechanical motor positioned within the column 402 to allow therobotic arms 406 to have access to multiples sides of the table 404,such as, for example, both sides of the patient. In embodiments withmultiple carriages 502, the carriages 502 may be individually positionedon the column 402 and may translate and/or rotate independent of theother carriages 502. While carriages 502 need not surround the column402 or even be circular, the ring-shape as shown facilitates rotation ofthe carriages 502 around the column 402 while maintaining structuralbalance. Rotation and translation of the carriages 502 allows the system400 to align medical instruments, such as endoscopes and laparoscopes,into different access points on the patient.

In other embodiments (discussed in greater detail below with respect toFIG. 9A), the system 400 can include a patient table or bed withadjustable arm supports in the form of bars or rails extending alongsideit. One or more robotic arms 406 (e.g., via a shoulder with an elbow joint) can be attached to the adjustable arm supports, which can bevertically adjusted. By providing vertical adjustment, the robotic arms406 are advantageously capable of being stowed compactly beneath thepatient table or bed, and subsequently raised during a procedure.

The arms 406 may be mounted on the carriages 502 through a set of armmounts 506 comprising a series of joints that may individually rotateand/or telescopically extend to provide additional configurability tothe robotic arms 406. Additionally, the arm mounts 506 may be positionedon the carriages 502 such that when the carriages 502 are appropriatelyrotated, the arm mounts 506 may be positioned on either the same side ofthe table 404 (as shown in FIG. 5 ), on opposite sides of table 404 (asshown in FIG. 7B), or on adjacent sides of the table 404 (not shown).

The column 402 structurally provides support for the table 404, and apath for vertical translation of the carriages 502. Internally, thecolumn 402 may be equipped with lead screws for guiding verticaltranslation of the carriages, and motors to mechanize the translation ofsaid carriages based the lead screws. The column 402 may also conveypower and control signals to the carriage 502 and robotic arms 406mounted thereon.

A table base 508 serves a similar function as the cart base 204 of thecart 102 shown in FIG. 2 , housing heavier components to balance thetable/bed 404, the column 402, the carriages 502, and the robotic arms406. The table base 508 may also incorporate rigid casters to providestability during procedures. Deployed from the bottom of the table base508, the casters may extend in opposite directions on both sides of thebase 508 and retract when the system 400 needs to be moved.

In some embodiments, the system 400 may also include a tower (not shown)that divides the functionality of system 400 between table and tower toreduce the form factor and bulk of the table 404. As in earlierdisclosed embodiments, the tower may provide a variety of supportfunctionalities to the table 404, such as processing, computing, andcontrol capabilities, power, fluidics, and/or optical and sensorprocessing. The tower may also be movable to be positioned away from thepatient to improve physician access and de-clutter the operating room.Additionally, placing components in the tower allows for more storagespace in the table base 508 for potential stowage of the robotic arms406. The tower may also include a master controller or console thatprovides both a user interface for user input, such as keyboard and/orpendant, as well as a display screen (or touchscreen) for pre-operativeand intra-operative information, such as real-time imaging, navigation,and tracking information. In some embodiments, the tower may alsocontain holders for gas tanks to be used for insufflation.

In some embodiments, a table base may stow and store the robotic armswhen not in use. FIG. 6 illustrates an embodiment of the system 400 thatis configured to stow robotic arms in an embodiment of the table-basedsystem. In the system 400, one or more carriages 602 (one shown) may bevertically translated into a base 604 to stow one or more robotic arms606, one or more arm mounts 608, and the carriages 602 within the base604. Base covers 610 may be translated and retracted open to deploy thecarriages 602, the arm mounts 608, and the arms 606 around the column612, and closed to stow and protect them when not in use. The basecovers 610 may be sealed with a membrane 614 along the edges of itsopening to prevent dirt and fluid ingress when closed.

FIG. 7A illustrates an embodiment of the robotically-enabled table-basedsystem 400 configured for a ureteroscopy procedure. In ureteroscopy, thetable 404 may include a swivel portion 702 for positioning a patientoff-angle from the column 402 and the table base 508. The swivel portion702 may rotate or pivot around a pivot point (e.g., located below thepatient’s head) in order to position the bottom portion of the swivelportion 702 away from the column 402. For example, the pivoting of theswivel portion 702 allows a C-arm (not shown) to be positioned over thepatient’s lower abdomen without competing for space with the column (notshown) below table 404. By rotating the carriage (not shown) around thecolumn 402, the robotic arms 406 may directly insert a ureteroscope 704along a virtual rail 706 into the patient’s groin area to reach theurethra. In ureteroscopy, stirrups 708 may also be fixed to the swivelportion 702 of the table 404 to support the position of the patient’slegs during the procedure and allow clear access to the patient’s groinarea.

FIG. 7B illustrates an embodiment of the system 400 configured for alaparoscopic procedure. In a laparoscopic procedure, through smallincision(s) in the patient’s abdominal wall, minimally invasiveinstruments may be inserted into the patient’s anatomy. In someembodiments, the minimally invasive instruments comprise an elongatedrigid member, such as a shaft, which is used to access anatomy withinthe patient. After inflation of the patient’s abdominal cavity, theinstruments may be directed to perform surgical or medical tasks, suchas grasping, cutting, ablating, suturing, etc. In some embodiments, theinstruments can comprise a scope, such as a laparoscope. As shown inFIG. 7B, the carriages 502 of the system 400 may be rotated andvertically adjusted to position pairs of the robotic arms 406 onopposite sides of the table 404, such that an instrument 710 may bepositioned using the arm mounts 506 to be passed through minimalincisions on both sides of the patient to reach his/her abdominalcavity.

To accommodate laparoscopic procedures, the system 400 may also tilt theplatform to a desired angle. FIG. 7C illustrates an embodiment of thesystem 400 with pitch or tilt adjustment. As shown in FIG. 7C, thesystem 400 may accommodate tilt of the table 404 to position one portionof the table 404 at a greater distance from the floor than the other.Additionally, the arm mounts 506 may rotate to match the tilt such thatthe arms 406 maintain the same planar relationship with table 404. Toaccommodate steeper angles, the column 402 may also include telescopingportions 712 that allow vertical extension of the column 402 to keep thetable 404 from touching the floor or colliding with the base 508.

FIG. 8 provides a detailed illustration of the interface between thetable 404 and the column 402. Pitch rotation mechanism 802 may beconfigured to alter the pitch angle of the table 404 relative to thecolumn 402 in multiple degrees of freedom. The pitch rotation mechanism802 may be enabled by the positioning of orthogonal axes A and B at thecolumn-table interface, each axis actuated by a separate motor 804 a and804 b responsive to an electrical pitch angle command. Rotation alongone screw 806 a would enable tilt adjustments in one axis A, whilerotation along another screw 806 b would enable tilt adjustments alongthe other axis B. In some embodiments, a ball joint can be used to alterthe pitch angle of the table 404 relative to the column 402 in multipledegrees of freedom.

For example, pitch adjustments are particularly useful when trying toposition the table in a Trendelenburg position, i.e., position thepatient’s lower abdomen at a higher position from the floor than thepatient’s lower abdomen, for lower abdominal surgery. The Trendelenburgposition causes the patient’s internal organs to slide towards his/herupper abdomen through the force of gravity, clearing out the abdominalcavity for minimally invasive tools to enter and perform lower abdominalsurgical or medical procedures, such as laparoscopic prostatectomy.

FIGS. 9A and 9B illustrate isometric and end views, respectively, of analternative embodiment of a table-based surgical robotics system 900.The surgical robotics system 900 includes one or more adjustable armsupports 902 that can be configured to support one or more robotic arms(see, for example, FIG. 9C) relative to a table 904. In the illustratedembodiment, a single adjustable arm support 902 is shown, though anadditional arm support can be provided on an opposite side of the table904. The adjustable arm support 902 can be configured so that it canmove relative to the table 904 to adjust and/or vary the position of theadjustable arm support 902 and/or any robotic arms mounted theretorelative to the table 904. For example, the adjustable arm support 902may be adjusted in one or more degrees of freedom relative to the table904. The adjustable arm support 902 provides high versatility to thesystem 900, including the ability to easily stow the one or moreadjustable arm supports 902 and any robotics arms attached theretobeneath the table 904. The adjustable arm support 902 can be elevatedfrom the stowed position to a position below an upper surface of thetable 904. In other embodiments, the adjustable arm support 902 can beelevated from the stowed position to a position above an upper surfaceof the table 904.

The adjustable arm support 902 can provide several degrees of freedom,including lift, lateral translation, tilt, etc. In the illustratedembodiment of FIGS. 9A and 9B, the arm support 902 is configured withfour degrees of freedom, which are illustrated with arrows in FIG. 9A. Afirst degree of freedom allows for adjustment of the adjustable armsupport 902 in the z-direction (“Z-lift”). For example, the adjustablearm support 902 can include a carriage 906 configured to move up or downalong or relative to a column 908 supporting the table 904. A seconddegree of freedom can allow the adjustable arm support 902 to tilt. Forexample, the adjustable arm support 902 can include a rotary joint,which can allow the adjustable arm support 902 to be aligned with thebed in a Trendelenburg position. A third degree of freedom can allow theadjustable arm support 902 to “pivot up,” which can be used to adjust adistance between a side of the table 904 and the adjustable arm support902. A fourth degree of freedom can permit translation of the adjustablearm support 902 along a longitudinal length of the table.

The surgical robotics system 900 in FIGS. 9A and 9B can comprise a table904 supported by a column 908 that is mounted to a base 910. The base910 and the column 908 support the table 904 relative to a supportsurface. A floor axis 912 and a support axis 914 are shown in FIG. 9B.

The adjustable arm support 902 can be mounted to the column 908. Inother embodiments, the arm support 902 can be mounted to the table 904or the base 910. The adjustable arm support 902 can include a carriage906, a bar or rail connector 916 and a bar or rail 918. In someembodiments, one or more robotic arms mounted to the rail 918 cantranslate and move relative to one another.

The carriage 906 can be attached to the column 908 by a first joint 920,which allows the carriage 906 to move relative to the column 908 (e.g.,such as up and down a first or vertical axis 922). The first joint 920can provide the first degree of freedom (“Z-lift”) to the adjustable armsupport 902. The adjustable arm support 902 can include a second joint924, which provides the second degree of freedom (tilt) for theadjustable arm support 902. The adjustable arm support 902 can include athird joint 926, which can provide the third degree of freedom (“pivotup”) for the adjustable arm support 902. An additional joint 928 (shownin FIG. 9B) can be provided that mechanically constrains the third joint926 to maintain an orientation of the rail 918 as the rail connector 916is rotated about a third axis 930. The adjustable arm support 902 caninclude a fourth joint 932, which can provide a fourth degree of freedom(translation) for the adjustable arm support 902 along a fourth axis934.

FIG. 9C illustrates an end view of the surgical robotics system 900 withtwo adjustable arm supports 902 a and 902 b mounted on opposite sides ofthe table 904. A first robotic arm 936 a is attached to the first bar orrail 918 a of the first adjustable arm support 902 a. The first roboticarm 936 a includes a base 938 a attached to the first rail 918 a. Thedistal end of the first robotic arm 936 a includes an instrument drivemechanism or input 940 a that can attach to one or more robotic medicalinstruments or tools. Similarly, the second robotic arm 936 b includes abase 938 a attached to the second rail 918 b. The distal end of thesecond robotic arm 936 b includes an instrument drive mechanism or input940 b configured to attach to one or more robotic medical instruments ortools.

In some embodiments, one or more of the robotic arms 936 a,b comprisesan arm with seven or more degrees of freedom. In some embodiments, oneor more of the robotic arms 936 a,b can include eight degrees offreedom, including an insertion axis (1-degree of freedom includinginsertion), a wrist (3-degrees of freedom including wrist pitch, yaw androll), an elbow (1-degree of freedom including elbow pitch), a shoulder(2-degrees of freedom including shoulder pitch and yaw), and base 938a,b (1-degree of freedom including translation). In some embodiments,the insertion degree of freedom can be provided by the robotic arm 936a,b, while in other embodiments, the instrument itself providesinsertion via an instrument-based insertion architecture.

C Instrument Driver & Interface

The end effectors of a system’s robotic arms comprise (i) an instrumentdriver (alternatively referred to as “tool driver,” “instrument drivemechanism,” “instrument device manipulator,” and “drive input”) thatincorporate electro-mechanical means for actuating the medicalinstrument, and (ii) a removable or detachable medical instrument, whichmay be devoid of any electro-mechanical components, such as motors. Thisdichotomy may be driven by the need to sterilize medical instrumentsused in medical procedures, and the inability to adequately sterilizeexpensive capital equipment due to their intricate mechanical assembliesand sensitive electronics. Accordingly, the medical instruments may bedesigned to be detached, removed, and interchanged from the instrumentdriver (and thus the system) for individual sterilization or disposal bythe physician or the physician’s staff. In contrast, the instrumentdrivers need not be changed or sterilized, and may be draped forprotection.

FIG. 10 illustrates an example instrument driver 1000, according to oneor more embodiments. Positioned at the distal end of a robotic arm, theinstrument driver 1000 includes one or more drive outputs 1002 arrangedwith parallel axes to provide controlled torque to a medical instrumentvia corresponding drive shafts 1004. Each drive output 1002 comprises anindividual drive shaft 1004 for interacting with the instrument, a gearhead 1006 for converting the motor shaft rotation to a desired torque, amotor 1008 for generating the drive torque, and an encoder 1010 tomeasure the speed of the motor shaft and provide feedback to controlcircuitry 1012, which can also be used for receiving control signals andactuating the drive output 1002. Each drive output 1002 beingindependently controlled and motorized, the instrument driver 1000 mayprovide multiple (at least two shown in FIG. 10 ) independent driveoutputs to the medical instrument. In operation, the control circuitry1012 receives a control signal, transmits a motor signal to the motor1008, compares the resulting motor speed as measured by the encoder 1010with the desired speed, and modulates the motor signal to generate thedesired torque.

For procedures that require a sterile environment, the robotic systemmay incorporate a drive interface, such as a sterile adapter connectedto a sterile drape that sits between the instrument driver and themedical instrument. The chief purpose of the sterile adapter is totransfer angular motion from the drive shafts of the instrument driverto the drive inputs of the instrument while maintaining physicalseparation, and thus sterility, between the drive shafts and driveinputs. Accordingly, an example sterile adapter may comprise a series ofrotational inputs and outputs intended to be mated with the drive shaftsof the instrument driver and drive inputs on the instrument. Connectedto the sterile adapter, the sterile drape, comprised of a thin, flexiblematerial such as transparent or translucent plastic, is designed tocover the capital equipment, such as the instrument driver, robotic arm,and cart (in a cart-based system) or table (in a table-based system).Use of the drape would allow the capital equipment to be positionedproximate to the patient while still being located in an area notrequiring sterilization (i.e., non-sterile field). On the other side ofthe sterile drape, the medical instrument may interface with the patientin an area requiring sterilization (i.e., sterile field).

D Medical Instrument

FIG. 11 illustrates an example medical instrument 1100 with a pairedinstrument driver 1102. Like other instruments designed for use with arobotic system, the medical instrument 1100 (alternately referred to asa “surgical tool”) comprises an elongated shaft 1104 (or elongate body)and an instrument base 1106. The instrument base 1106, also referred toas an “instrument handle” due to its intended design for manualinteraction by the physician, may generally comprise rotatable driveinputs 1108, e.g., receptacles, pulleys or spools, that are designed tobe mated with drive outputs 1110 that extend through a drive interfaceon the instrument driver 1102 at the distal end of a robotic arm 1112.When physically connected, latched, and/or coupled, the mated driveinputs 1108 of the instrument base 1106 may share axes of rotation withthe drive outputs 1110 in the instrument driver 1102 to allow thetransfer of torque from the drive outputs 1110 to the drive inputs 1108.In some embodiments, the drive outputs 1110 may comprise splines thatare designed to mate with receptacles on the drive inputs 1108.

The elongated shaft 1104 is designed to be delivered through either ananatomical opening or lumen, e.g., as in endoscopy, or a minimallyinvasive incision, e.g., as in laparoscopy. The elongated shaft 1104 maybe either flexible (e.g., having properties similar to an endoscope) orrigid (e.g., having properties similar to a laparoscope) or contain acustomized combination of both flexible and rigid portions. Whendesigned for laparoscopy, the distal end of the shaft 1104 may beconnected to an end effector extending from a jointed wrist formed froma clevis with at least one degree of freedom and a surgical tool ormedical instrument, such as, for example, a grasper or scissors, thatmay be actuated based on force from the tendons as the drive inputs 1008rotate in response to torque received from the drive outputs 1110 of theinstrument driver 1102. When designed for endoscopy, the distal end ofthe flexible elongated shaft 1104 may include a steerable orcontrollable bending section that may be articulated and bent based ontorque received from the drive outputs 1110 of the instrument driver1102.

In some embodiments, torque from the instrument driver 1102 istransmitted down the elongated shaft 1104 using tendons along the shaft1104. These individual tendons, such as pull wires, may be individuallyanchored to individual drive inputs 1108 within the instrument handle1106. From the handle 1106, the tendons are directed down one or morepull lumens along the elongated shaft 1104 and anchored at the distalportion of the elongated shaft 1104, or in the wrist at the distalportion of the elongated shaft. During a surgical procedure, such as alaparoscopic, endoscopic, or a hybrid procedure, these tendons may becoupled to a distally mounted end effector, such as a wrist, a grasper,or scissors. Under such an arrangement, torque exerted on the driveinputs 1108 would transfer tension to the tendon, thereby causing theend effector to actuate in some way. In some embodiments, during asurgical procedure, the tendon may cause a joint to rotate about anaxis, thereby causing the end effector to move in one direction oranother. Alternatively, the tendon may be connected to one or more jawsof a grasper at distal end of the elongated shaft 1104, where tensionfrom the tendon cause the grasper to close.

In endoscopy, the tendons may be coupled to a bending or articulatingsection positioned along the elongated shaft 1104 (e.g., at the distalend) via adhesive, control ring, or other mechanical fixation. Whenfixedly attached to the distal end of a bending section, torque exertedon drive inputs 1108 would be transmitted down the tendons, causing thesofter, bending section (sometimes referred to as the articulablesection or region) to bend or articulate. Along the non-bendingsections, it may be advantageous to spiral or helix the individual pulllumens that direct the individual tendons along (or inside) the walls ofthe endoscope shaft to balance the radial forces that result fromtension in the pull wires. The angle of the spiraling and/or spacingthere between may be altered or engineered for specific purposes,wherein tighter spiraling exhibits lesser shaft compression under loadforces, while lower amounts of spiraling results in greater shaftcompression under load forces, but also exhibits limits bending. On theother end of the spectrum, the pull lumens may be directed parallel tothe longitudinal axis of the elongated shaft 1104 to allow forcontrolled articulation in the desired bending or articulable sections.

In endoscopy, the elongated shaft 1104 houses a number of components toassist with the robotic procedure. The shaft may comprise a workingchannel for deploying surgical tools (or medical instruments),irrigation, and/or aspiration to the operative region at the distal endof the shaft 1104. The shaft 1104 may also accommodate wires and/oroptical fibers to transfer signals to/from an optical assembly at thedistal tip, which may include of an optical camera. The shaft 1104 mayalso accommodate optical fibers to carry light from proximally-locatedlight sources, such as light emitting diodes, to the distal end of theshaft.

At the distal end of the instrument 1100, the distal tip may alsocomprise the opening of a working channel for delivering tools fordiagnostic and/or therapy, irrigation, and aspiration to an operativesite. The distal tip may also include a port for a camera, such as afiberscope or a digital camera, to capture images of an internalanatomical space. Relatedly, the distal tip may also include ports forlight sources for illuminating the anatomical space when using thecamera.

In the example of FIG. 11 , the drive shaft axes, and thus the driveinput axes, are orthogonal to the axis of the elongated shaft. Thisarrangement, however, complicates roll capabilities for the elongatedshaft 1104. Rolling the elongated shaft 1104 along its axis whilekeeping the drive inputs 1108 static results in undesirable tangling ofthe tendons as they extend off the drive inputs 1108 and enter pulllumens within the elongated shaft 1104. The resulting entanglement ofsuch tendons may disrupt any control algorithms intended to predictmovement of the flexible elongated shaft during an endoscopic procedure.

FIG. 12 illustrates an alternative design for a circular instrumentdriver 1200 and corresponding instrument 1202 (alternately referred toas a “surgical tool”) where the axes of the drive units are parallel tothe axis of the elongated shaft 1206 of the instrument 1202. As shown,the instrument driver 1200 comprises four drive units with correspondingdrive outputs 1208 aligned in parallel at the end of a robotic arm 1210.The drive units and their respective drive outputs 1208 are housed in arotational assembly 1212 of the instrument driver 1200 that is driven byone of the drive units within the assembly 1212. In response to torqueprovided by the rotational drive unit, the rotational assembly 1212rotates along a circular bearing that connects the rotational assembly1212 to a non-rotational portion 1214 of the instrument driver 1200.Power and control signals may be communicated from the non-rotationalportion 1214 of the instrument driver 1200 to the rotational assembly1212 through electrical contacts maintained through rotation by abrushed slip ring connection (not shown). In other embodiments, therotational assembly 1212 may be responsive to a separate drive unit thatis integrated into the non-rotatable portion 1214, and thus not inparallel with the other drive units. The rotational assembly 1212 allowsthe instrument driver 1200 to rotate the drive units and theirrespective drive outputs 1208 as a single unit around an instrumentdriver axis 1216.

Like earlier disclosed embodiments, the instrument 1202 may include anelongated shaft 1206 and an instrument base 1218 (shown in phantom)including a plurality of drive inputs 1220 (such as receptacles,pulleys, and spools) that are configured to mate with the drive outputs1208 of the instrument driver 1200. Unlike prior disclosed embodiments,the instrument shaft 1206 extends from the center of the instrument base1218 with an axis substantially parallel to the axes of the drive inputs1220, rather than orthogonal as in the design of FIG. 11 .

When coupled to the rotational assembly 1212 of the instrument driver1200, the medical instrument 1202, comprising instrument base 1218 andinstrument shaft 1206, rotates in combination with the rotationalassembly 1212 about the instrument driver axis 1216. Since theinstrument shaft 1206 is positioned at the center of the instrument base1218, the instrument shaft 1206 is coaxial with the instrument driveraxis 1216 when attached. Thus, rotation of the rotational assembly 1212causes the instrument shaft 1206 to rotate about its own longitudinalaxis. Moreover, as the instrument base 1218 rotates with the instrumentshaft 1206, any tendons connected to the drive inputs 1220 in theinstrument base 1218 are not tangled during rotation. Accordingly, theparallelism of the axes of the drive outputs 1208, the drive inputs1220, and the instrument shaft 1206 allows for the shaft rotationwithout tangling any control tendons.

FIG. 13 illustrates a medical instrument 1300 having an instrument basedinsertion architecture in accordance with some embodiments. Theinstrument 1300 (alternately referred to as a “surgical tool”) can becoupled to any of the instrument drivers discussed herein above and, asillustrated, can include an elongated shaft 1302, an end effector 1304connected to the shaft 1302, and a handle 1306 coupled to the shaft1302. The elongated shaft 1302 comprises a tubular member having aproximal portion 1308 a and a distal portion 1308 b. The elongated shaft1302 comprises one or more channels or grooves 1310 along its outersurface and configured to receive one or more wires or cables 1312therethrough. One or more cables 1312 thus run along an outer surface ofthe elongated shaft 1302. In other embodiments, the cables 1312 can alsorun through the elongated shaft 1302. Manipulation of the cables 1312(e.g., via an instrument driver) results in actuation of the endeffector 1304.

The instrument handle 1306, which may also be referred to as aninstrument base, may generally comprise an attachment interface 1314having one or more mechanical inputs 1316, e.g., receptacles, pulleys orspools, that are designed to be reciprocally mated with one or moredrive outputs on an attachment surface of an instrument driver.

In some embodiments, the instrument 1300 comprises a series of pulleysor cables that enable the elongated shaft 1302 to translate relative tothe handle 1306. In other words, the instrument 1300 itself comprises aninstrument-based insertion architecture that accommodates insertion ofthe instrument 1300, thereby minimizing the reliance on a robot arm toprovide insertion of the instrument 1300. In other embodiments, arobotic arm can be largely responsible for instrument insertion.

E Controller

Any of the robotic systems described herein can include an input deviceor controller for manipulating an instrument attached to a robotic arm.In some embodiments, the controller can be coupled (e.g.,communicatively, electronically, electrically, wirelessly and/ormechanically) with an instrument such that manipulation of thecontroller causes a corresponding manipulation of the instrument e.g.,via master slave control.

FIG. 14 is a perspective view of an embodiment of a controller 1400. Inthe present embodiment, the controller 1400 comprises a hybridcontroller that can have both impedance and admittance control. In otherembodiments, the controller 1400 can utilize just impedance or passivecontrol. In other embodiments, the controller 1400 can utilize justadmittance control. By being a hybrid controller, the controller 1400advantageously can have a lower perceived inertia while in use.

In the illustrated embodiment, the controller 1400 is configured toallow manipulation of two medical instruments, and includes two handles1402. Each of the handles 1402 is connected to a gimbal 1404, and eachgimbal 1404 is connected to a positioning platform 1406.

As shown in FIG. 14 , each positioning platform 1406 includes aselective compliance assembly robot arm (SCARA) 1408 coupled to a column1410 by a prismatic joint 1412. The prismatic joints 1412 are configuredto translate along the column 1410 (e.g., along rails 1414) to alloweach of the handles 1402 to be translated in the z-direction, providinga first degree of freedom. The SCARA arm 1408 is configured to allowmotion of the handle 1402 in an x-y plane, providing two additionaldegrees of freedom.

In some embodiments, one or more load cells are positioned in thecontroller 1400. For example, in some embodiments, a load cell (notshown) is positioned in the body of each of the gimbals 1404. Byproviding a load cell, portions of the controller 1400 are capable ofoperating under admittance control, thereby advantageously reducing theperceived inertia of the controller 1400 while in use. In someembodiments, the positioning platform 1406 is configured for admittancecontrol, while the gimbal 1404 is configured for impedance control. Inother embodiments, the gimbal 1404 is configured for admittance control,while the positioning platform 1406 is configured for impedance control.Accordingly, for some embodiments, the translational or positionaldegrees of freedom of the positioning platform 1406 can rely onadmittance control, while the rotational degrees of freedom of thegimbal 1404 rely on impedance control.

F Navigation and Control

Traditional endoscopy may involve the use of fluoroscopy (e.g., as maybe delivered through a C-arm) and other forms of radiation-based imagingmodalities to provide endoluminal guidance to an operator physician. Incontrast, the robotic systems contemplated by this disclosure canprovide for non-radiation-based navigational and localization means toreduce physician exposure to radiation and reduce the amount ofequipment within the operating room. As used herein, the term“localization” may refer to determining and/or monitoring the positionof objects in a reference coordinate system. Technologies such aspre-operative mapping, computer vision, real-time EM tracking, and robotcommand data may be used individually or in combination to achieve aradiation-free operating environment. In other cases, whereradiation-based imaging modalities are still used, the pre-operativemapping, computer vision, real-time EM tracking, and robot command datamay be used individually or in combination to improve upon theinformation obtained solely through radiation-based imaging modalities.

FIG. 15 is a block diagram illustrating a localization system 1500 thatestimates a location of one or more elements of the robotic system, suchas the location of the instrument, in accordance to an exampleembodiment. The localization system 1500 may be a set of one or morecomputer devices configured to execute one or more instructions. Thecomputer devices may be embodied by a processor (or processors) andcomputer-readable memory in one or more components discussed above. Byway of example and not limitation, the computer devices may be in thetower 112 shown in FIG. 1 , the cart 102 shown in FIG. 1 -3B, the bedsshown in FIGS. 4-9 , etc.

As shown in FIG. 15 , the localization system 1500 may include alocalization module 1502 that processes input data 1504 a, 1504 b, 1504c, and 1504 d to generate location data 1506 for the distal tip of amedical instrument. The location data 1506 may be data or logic thatrepresents a location and/or orientation of the distal end of theinstrument relative to a frame of reference. The frame of reference canbe a frame of reference relative to the anatomy of the patient or to aknown object, such as an EM field generator (see discussion below forthe EM field generator).

The various input data 1504 a-d are now described in greater detail.Pre-operative mapping may be accomplished through the use of thecollection of low dose CT scans. Pre-operative CT scans arereconstructed into three-dimensional images, which are visualized, e.g.as “slices” of a cutaway view of the patient’s internal anatomy. Whenanalyzed in the aggregate, image-based models for anatomical cavities,spaces and structures of the patient’s anatomy, such as a patient lungnetwork, may be generated. Techniques such as center-line geometry maybe determined and approximated from the CT images to develop athree-dimensional volume of the patient’s anatomy, referred to as modeldata 1504 a (also referred to as “preoperative model data” whengenerated using only preoperative CT scans). The use of center-linegeometry is discussed in U.S. Pat. App. No. 14/523,760, the contents ofwhich are herein incorporated in its entirety. Network topologicalmodels may also be derived from the CT-images, and are particularlyappropriate for bronchoscopy.

In some embodiments, the instrument may be equipped with a camera toprovide vision data 1504 b. The localization module 1502 may process thevision data 1504 b to enable one or more vision-based location tracking.For example, the preoperative model data may be used in conjunction withthe vision data 1504 b to enable computer vision-based tracking of themedical instrument (e.g., an endoscope or an instrument advance througha working channel of the endoscope). For example, using the preoperativemodel data 1504 a, the robotic system may generate a library of expectedendoscopic images from the model based on the expected path of travel ofthe endoscope, each image linked to a location within the model.Intra-operatively, this library may be referenced by the robotic systemin order to compare real-time images captured at the camera (e.g., acamera at a distal end of the endoscope) to those in the image libraryto assist localization.

Other computer vision-based tracking techniques use feature tracking todetermine motion of the camera, and thus the endoscope. Some features ofthe localization module 1502 may identify circular geometries in thepreoperative model data 1504 a that correspond to anatomical lumens andtrack the change of those geometries to determine which anatomical lumenwas selected, as well as the relative rotational and/or translationalmotion of the camera. Use of a topological map may further enhancevision-based algorithms or techniques.

Optical flow, another computer vision-based technique, may analyze thedisplacement and translation of image pixels in a video sequence in thevision data 1504 b to infer camera movement. Examples of optical flowtechniques may include motion detection, object segmentationcalculations, luminance, motion compensated encoding, stereo disparitymeasurement, etc. Through the comparison of multiple frames overmultiple iterations, movement and location of the camera (and thus theendoscope) may be determined.

The localization module 1502 may use real-time EM tracking to generate areal-time location of the endoscope in a global coordinate system thatmay be registered to the patient’s anatomy, represented by thepreoperative model. In EM tracking, an EM sensor (or tracker) comprisingof one or more sensor coils embedded in one or more locations andorientations in a medical instrument (e.g., an endoscopic tool) measuresthe variation in the EM field created by one or more static EM fieldgenerators positioned at a known location. The location informationdetected by the EM sensors is stored as EM data 1504 c. The EM fieldgenerator (or transmitter), may be placed close to the patient to createa low intensity magnetic field that the embedded sensor may detect. Themagnetic field induces small currents in the sensor coils of the EMsensor, which may be analyzed to determine the distance and anglebetween the EM sensor and the EM field generator. These distances andorientations may be intra-operatively “registered” to the patientanatomy (e.g., the preoperative model) in order to determine thegeometric transformation that aligns a single location in the coordinatesystem with a position in the pre-operative model of the patient’sanatomy. Once registered, an embedded EM tracker in one or morepositions of the medical instrument (e.g., the distal tip of anendoscope) may provide real-time indications of the progression of themedical instrument through the patient’s anatomy.

Robotic command and kinematics data 1504 d may also be used by thelocalization module 1502 to provide localization data 1506 for therobotic system. Device pitch and yaw resulting from articulationcommands may be determined during pre-operative calibration.Intra-operatively, these calibration measurements may be used incombination with known insertion depth information to estimate theposition of the instrument. Alternatively, these calculations may beanalyzed in combination with EM, vision, and/or topological modeling toestimate the position of the medical instrument within the network.

As FIG. 15 shows, a number of other input data can be used by thelocalization module 1502. For example, although not shown in FIG. 15 ,an instrument utilizing shape-sensing fiber can provide shape data thatthe localization module 1502 can use to determine the location and shapeof the instrument.

The localization module 1502 may use the input data 1504 a-d incombination(s). In some cases, such a combination may use aprobabilistic approach where the localization module 1502 assigns aconfidence weight to the location determined from each of the input data1504 a-d. Thus, where the EM data 1504 c may not be reliable (as may bethe case where there is EM interference) the confidence of the locationdetermined by the EM data 1504 c can be decrease and the localizationmodule 1502 may rely more heavily on the vision data 1504 b and/or therobotic command and kinematics data 1504 d.

As discussed above, the robotic systems discussed herein may be designedto incorporate a combination of one or more of the technologies above.The robotic system’s computer-based control system, based in the tower,bed and/or cart, may store computer program instructions, for example,within a non-transitory computer-readable storage medium such as apersistent magnetic storage drive, solid state drive, or the like, that,upon execution, cause the system to receive and analyze sensor data anduser commands, generate control signals throughout the system, anddisplay the navigational and localization data, such as the position ofthe instrument within the global coordinate system, anatomical map, etc.

Description

FIG. 16 is an isometric side view of an example surgical tool 1600 thatmay incorporate some or all of the principles of the present disclosure.The surgical tool 1600 may be similar in some respects to any of thesurgical tools and medical instruments described above with reference toFIGS. 11-13 and, therefore, may be used in conjunction with a roboticsurgical system, such as the robotically-enabled systems 100, 400, and900 of FIGS. 1-9C. As illustrated, the surgical tool 1600 includes anelongated shaft 1602, an end effector 1604 arranged at the distal end ofthe shaft 1602, and an articulable wrist 1606 (alternately referred toas a “wrist joint”) that interposes and couples the end effector 1604 tothe distal end of the shaft 1602. In some embodiments, the wrist 1606may be omitted, without departing from the scope of the disclosure.

The terms “proximal” and “distal” are defined herein relative to arobotic surgical system having an interface configured to mechanicallyand electrically couple the surgical tool 1600 to a robotic manipulator.The term “proximal” refers to the position of an element closer to therobotic manipulator and the term “distal” refers to the position of anelement closer to the end effector 1604 and thus closer to the patientduring operation. Moreover, the use of directional terms such as above,below, upper, lower, upward, downward, left, right, and the like areused in relation to the illustrative embodiments as they are depicted inthe figures, the upward or upper direction being toward the top of thecorresponding figure and the downward or lower direction being towardthe bottom of the corresponding figure.

The surgical tool 1600 can have any of a variety of configurationscapable of performing one or more surgical functions. In the illustratedembodiment, the end effector 1604 comprises a vessel sealer capable ofcutting and cauterizing/sealing tissue or vessels. The end effector 1604includes opposing jaws 1610, 1612 configured to move (articulate)between open and closed positions. Alternatively, the end effector 1604may comprise other types of instruments with opposing jaws such as, butnot limited to, a surgical stapler, tissue graspers, surgical scissors,clip appliers, needle drivers, a babcock including a pair of opposedgrasping jaws, bipolar jaws (e.g., bipolar Maryland grasper, forceps, afenestrated grasper, etc.), etc.

One or both of the jaws 1610, 1612 may be configured to pivot to actuatethe end effector 1604 between open and closed positions. In theillustrated example, both jaws 1610, 1612 simultaneously move to pivotthe jaws 1610, 1612 between an open, unclamped position and a closed,clamped position and are thus referred to as “bifurcating” jaws. Inother embodiments, however, only one of the jaws 1610, 1612 may berotatable (pivotable) relative to the opposing jaw to actuate the endeffector 1604 between the open and closed positions.

The wrist 1606 enables the end effector 1604 to articulate (pivot)relative to the shaft 1602 and thereby position the end effector 1604 atvarious desired orientations and locations relative to a surgical site.In the illustrated embodiment, the wrist 1606 is designed to allow theend effector 1604 to pivot (swivel) left and right relative to alongitudinal axis A₁ of the shaft 1602. In other embodiments, however,the wrist 1606 may be designed to provide multiple degrees of freedom,including one or more translational variables (i.e., surge, heave, andsway) and/or one or more rotational variables (i.e., Euler angles orroll, pitch, and yaw). The translational and rotational variablesdescribe the position and orientation of a component of a surgicalsystem (e.g., the end effector 1604) with respect to a given referenceCartesian frame. “Surge” refers to forward and backward translationalmovement, “heave” refers to translational movement up and down, and“sway” refers to translational movement left and right. With regard tothe rotational terms, “roll” refers to tilting side to side, “pitch”refers to tilting forward and backward, and “yaw” refers to turning leftand right.

The end effector 1604 is depicted in FIG. 16 in the unarticulatedposition where the longitudinal axis of the end effector 1604 issubstantially aligned with the longitudinal axis A₁ of the shaft 1602,such that the end effector 1604 is at a substantially zero anglerelative to the shaft 1602. In the articulated position, thelongitudinal axis of the end effector 1604 would be angularly offsetfrom the longitudinal axis A₁ such that the end effector 1604 would beoriented at a non-zero angle relative to the shaft 1602.

Still referring to FIG. 16 , the surgical tool 1600 may include a drivehousing or “handle” 1614, and the shaft 1602 extends longitudinallythrough the handle 1614. The handle 1614 houses an actuation systemdesigned to move the shaft 1602 relative to (through) the handle 1614,and further designed to facilitate articulation of the wrist 1606 andactuation (operation) of the end effector 1604 (e.g., clamping, firing,rotation, articulation, energy delivery, etc.). More specifically, thesystems and mechanisms housed within the handle 1614 are actuatable tomove (translate) a plurality of drive members that extend along at leasta portion of the shaft 1602, either on the exterior or within theinterior of the shaft 1602. Example drive members include, but are notlimited to, cables, bands, lines, cords, wires, woven wires, ropes,strings, twisted strings, elongate members, belts, shafts, flexibleshafts, drive rods, or any combination thereof. The drive members can bemade from a variety of materials including, but not limited to, a metal(e.g., tungsten, stainless steel, nitinol, etc.) a polymer (e.g.,ultra-high molecular weight polyethylene), a synthetic fiber (e.g.,KEVLAR®, VECTRAN®, etc.), an elastomer, or any combination thereof.

Selective actuation of one or more of the drive members, for example,may cause the shaft 1602 to translate relative to the handle 1614, asindicated by the arrows B, and thereby advance or retract the endeffector 1602. Selective actuation of one or more other drive membersmay cause the end effector 1604 to articulate (pivot) relative to theshaft 1602 at the wrist 1606. Selective actuation of one or moreadditional drive members may cause the end effector 1604 to actuate(operate). Actuating the end effector 1604 depicted in FIG. 16 mayentail closing and/or opening the jaws, 1610, 1612 and thereby enablingthe end effector 1604 to grasp (clamp) onto tissue. Once tissue isgrasped or clamped between the opposing jaws 1610, 1612, actuating theend effector 1604 may further include “firing” the end effector 1604,which may refer to causing a cutting element or knife (not visible) toadvance distally within a slot or “guide track” 1616 defined in thefirst jaw 1610. As it moves distally within the guide track 1616, theknife transects any tissue grasped between the opposing jaws 1610, 1612.In at least one embodiment, actuating the end effector 1604 may furtherentail triggering energy delivery (e.g., RF energy) to cauterize and/orseal tissue or vessels grasped between the jaws 1610, 1612.

The handle 1614 provides or otherwise includes various coupling featuresthat releasably couple the surgical tool 1600 to an instrument driver1618 (shown in dashed lines) of a robotic surgical system. Theinstrument driver 1618 may be similar in some respects to the instrumentdrivers 1102, 1200 of FIGS. 11 and 12 , respectively, and therefore maybe best understood with reference thereto. Similar to the instrumentdrivers 1102, 1200, for example, the instrument driver 1618 may bemounted to or otherwise positioned at the end of a robotic arm (notshown) and is designed to provide the motive forces required to operatethe surgical tool 1600. Unlike the instrument drivers 1102, 1200,however, the shaft 1602 of the surgical tool 1600 extends through andpenetrates the instrument driver 1618.

The handle 1614 includes one or more rotatable drive inputs matable withone or more corresponding drive outputs (not shown) of the instrumentdriver 1618. Each drive input is actuatable to independently drive(actuate) the systems and mechanisms housed within the handle 1614 andthereby operate the surgical tool 1600. In the illustrated embodiment,the handle 1614 includes a first drive input 1620 a, a second driveinput 1620 b, a third drive input 1620 c, a fourth drive input 1620 d, afifth drive input 1620 e, and a sixth drive input 1620 f. While sixdrive inputs 1620 a-f are depicted, more or less than six may beincluded in the handle 1614 depending on the application, and withoutdeparting from the scope of the disclosure. Each drive input 1620 a-fmay be matable with a corresponding drive output (not shown) of theinstrument driver 1618 such that movement (rotation) of a given driveoutput correspondingly moves (rotates) the associated drive input 1620a-f and thereby causes various operations of the surgical tool 1600.

In some embodiments, actuation of the first drive input 1620 a may causethe knife to fire at the end effector 1604, thus advancing or retractingthe knife, depending on the rotational direction of the first driveinput 1620 a. Actuation of the third drive input 1620 c may cause theshaft 1602 to move (translate) relative to the handle 1614 along thelongitudinal axis A₁, depending on the rotational direction of the thirddrive input 1620 c. In some embodiments, actuation of the second driveinput 1620 b may shift operation or activation within the handle 1614between the first and third drive inputs 1620 a,c. Consequently,actuation of the second drive input 1620 b may dictate whether the knifeis fired or whether the shaft 1602 is moved (translated). Actuation ofthe fourth drive input 1620 d may lock and unlock z-axis translation ofthe shaft 1602, and actuation of the fifth drive input 1620 e may causearticulation of the end effector 1604 at the wrist 1606. Lastly,actuation of the sixth drive input 1620 f may cause the jaws 1610, 1612to open or close, depending on the rotational direction of the sixthdrive input 1620 f. In some embodiments, actuation of the sixth driveinput 1620 f may operate a toggle mechanism 1622 arranged at theproximal end of the shaft 1602, and actuation of the toggle mechanism1622 may cause the jaws 1610, 1612 to open and close. Those skilled inthe art, however, will readily appreciate that the handle 1614 may bealternatively designed such that the drive inputs 1620 a-f carry outother functions, without departing from the scope of the disclosure.Indeed, the operations described above for the drive inputs 1620 a-f aremerely provided as examples, and alternative configurations oroperations may instead be provided.

FIG. 17 depicts separated isometric end views of the instrument driver1618 and the surgical tool 1600 of FIG. 16 . With the jaws 1610, 1612closed, the shaft 1602 and the end effector 1604 can penetrate theinstrument driver 1618 by extending through a central aperture 1702defined longitudinally through the instrument driver 1618 between firstand second ends 1704 a,b. In some embodiments, to align the surgicaltool 1600 with the instrument driver 1618 in a proper angularorientation, one or more alignment guides 1706 may be provided orotherwise defined within the central aperture 1702 and configured toengage one or more corresponding alignment features (not shown) providedon the surgical tool 1600. The alignment feature(s) may comprise, forexample, a protrusion or projection (not shown) defined on or otherwiseprovided by an alignment nozzle 1708 extending distally from the handle1614. In one or more embodiments, the alignment guide(s) 1706 maycomprise a curved or arcuate shoulder or lip configured to receive andguide the alignment feature as the alignment nozzle 1708 enters thecentral aperture 1702. As a result, the surgical tool 1600 is orientedto a proper angular alignment with the instrument driver 1618 as thealignment nozzle 1708 is advanced distally through the central aperture1702. In other embodiments, the alignment nozzle 1708 may be omitted andthe alignment feature 1712 may alternatively be provided on the shaft1602, without departing from the scope of the disclosure.

A drive interface 1710 is provided at the first end 1704 a of theinstrument driver 1618 and is matable with a driven interface 1712provided on the distal end of the handle 1614. The drive and driveninterfaces 1710, 1712 may be configured to mechanically, magnetically,and/or electrically couple the handle 1614 to the instrument driver1618. To accomplish this, in some embodiments, the drive and driveninterfaces 1710, 1712 may provide one or more matable locating featuresconfigured to secure the handle 1614 to the instrument driver 1618. Inthe illustrated embodiment, for example, the drive interface 1710provides one or more interlocking features 1714 (three shown) configuredto locate and mate with one or more complementary-shaped pockets 1716(two shown, one occluded) provided on the driven interface 1712. In someembodiments, the features 1714 may be configured to align and mate withthe pockets 1716 via an interference or snap fit engagement, forexample.

The instrument driver 1618 also includes one or more drive outputs thatextend through the drive interface 1710 to mate with corresponding driveinputs 1620 a-f provided at the distal end of the handle 1614. Morespecifically, the instrument driver 1618 includes a first drive output1718 a matable with the first drive input 1620 a, a second drive output1718 b matable with the second drive input 1620 b, a third drive output1718 b matable with the third drive input 1620 c, a fourth drive output1718 d matable with the fourth drive input 1620 d, a fifth drive output1718 e matable with the fifth drive input 1620 e, and a sixth driveoutput 1718 f matable with the sixth drive input 1620 f. In someembodiments, as illustrated, the drive outputs 1718 a-f may definesplines or other mechanical features designed to mate with correspondingsplined receptacles of the drive inputs 1620 a-f. Once properly mated,the drive inputs 1620 a-f will share axes of rotation with thecorresponding drive outputs 1718 a-f to allow the transfer of rotationaltorque from the drive outputs 1718 a-f to the corresponding drive inputs1620 a-f. In some embodiments, each drive output 1718 a-f may be springloaded and otherwise biased to spring outwards away from the driveinterface 1710. Each drive output 1718 a-f may be capable of partiallyor fully retracting into the drive interface 1710.

In some embodiments, the instrument driver 1618 may include additionaldrive outputs, depicted in FIG. 17 as a seventh drive output 1718 g. Theseventh drive output 1718 g may be configured to mate with additionaldrive inputs (not shown) of the handle 1614 to help undertake one ormore additional functions of the surgical tool 1600. In the illustratedembodiment, however, the handle 1614 does not include additional driveinputs matable with the seventh drive output 1718 g. Instead, the driveninterface 1712 defines a corresponding recess 1720 (partially occluded)configured to receive the seventh drive output 1718 g. In otherapplications, however, a seventh drive input (not shown) could beincluded in the handle 1614 to mate with the seventh drive output 1718g, or the surgical tool 1600 might be replaced with another surgicaltool having a seventh drive input, which would be driven by the seventhdrive output 1718 g.

While not shown, in some embodiments, an instrument sterile adapter(ISA) may be placed at the interface between the instrument driver 1618and the handle 1614. In such applications, the interlocking features1714 may operate as alignment features and possible latches for the ISAto be placed, stabilized, and secured. Stability of the ISA may beaccomplished by a nose cone feature provided by the ISA and extendinginto the central aperture 1702 of the instrument driver 1618. Latchingcan occur either with the interlocking features 1714 or at otherlocations at the interface. In some cases, the ISA will provide themeans to help align and facilitate the latching of the surgical tool1600 to the ISA and simultaneously to the instrument driver 1618.

FIG. 18 is an enlarged isometric view of the distal end of the surgicaltool 1600 of FIGS. 16 and 17 . As illustrated, the wrist 1606 interposesthe shaft 1602 and the end effector 1604 and thereby operatively couplesthe end effector 1604 to the shaft 1602. In some embodiments, however, ashaft adapter may be directly coupled to the wrist 1606 and otherwiseinterpose the shaft 1602 and the wrist 1606. Accordingly, the wrist 1606may be operatively coupled to the shaft 1602 either through a directcoupling engagement where the wrist 1606 is directly coupled to thedistal end of the shaft 1602, or an indirect coupling engagement where ashaft adapter interposes the wrist 1606 and the distal end of the shaft1602. As used herein, the term “operatively couple” refers to a director indirect coupling engagement between two components.

To operatively couple the end effector 1604 to the shaft 1602, the wrist1606 includes a first or “distal” clevis 1802 a and a second or“proximal” clevis 1802 b. The clevises 1802 a,b are alternativelyreferred to as “articulation joints” of the wrist 1606 and extend fromthe shaft 1602, or alternatively a shaft adapter. The clevises 1802 a,bare operatively coupled to facilitate articulation of the wrist 1606relative to the shaft 1602. As illustrated, the wrist 1606 also includesa linkage 1804 arranged distal to the distal clevis 1802 a andoperatively mounted to the jaws 1610, 1612.

As illustrated, the proximal end of the distal clevis 1802 a may berotatably mounted or pivotably coupled to the proximal clevis 1802 b ata first pivot axis P₁ of the wrist 1602. In some embodiments, an axlemay extend through the first pivot axis P₁ and the distal and proximalclevises 1802 a,b may be rotatably coupled via the axle. In otherembodiments, however, such as is depicted in FIG. 18 , the distal andproximal clevises 1802 a,b may be engaged in rolling contact, such asvia an intermeshed gear relationship (not shown) that allows theclevises 1802 a,b to rotate relative to each other similar to a rollingjoint. Accordingly, the first pivot axis P₁ will be referred to hereinas the rolling joint P₁.

First and second pulleys 1806 a and 1806 b may be rotatably mounted tothe distal end of the distal clevis 1802 a at a second pivot axis P₂ ofthe wrist 1602. The linkage 1804 may be arranged distal to the secondpivot axis P₂ and operatively mounted to the jaws 1610, 1612. Therolling joint P₁ is substantially perpendicular (orthogonal) to thelongitudinal axis A₁ of the shaft 1602, and the second pivot axis P₂ issubstantially perpendicular (orthogonal) to both the longitudinal axisA₁ and the rolling joint P₁. Movement of the end effector 1604 about therolling joint P₁ provides “yaw” articulation of the wrist 1606, andmovement about the second pivot axis P₂ provides “pitch” articulation ofthe wrist 1606.

A plurality of drive members, shown as drive members 1808 a, 1808 b,1808 c, and 1808 d, extend longitudinally within a lumen 1810 defined bythe shaft 1602 (or a shaft adaptor) and extend at least partiallythrough the wrist 1606. The drive members 1808 a-d may form part of theactuation systems housed within the handle 1614 (FIGS. 16 and 17 ), andmay comprise cables, bands, lines, cords, wires, woven wires, ropes,strings, twisted strings, elongate members, belts, shafts, flexibleshafts, drive rods, or any combination thereof. The drive members 1808a-d can be made from a variety of materials including, but not limitedto, a metal (e.g., tungsten, stainless steel, nitinol, etc.) a polymer(e.g., ultra-high molecular weight polyethylene), a synthetic fiber(e.g., KEVLAR®, VECTRAN®, etc.), an elastomer, or any combinationthereof. While four drive members 1808 a-d are depicted in FIG. 18 ,more or less than four may be employed, without departing from the scopeof the disclosure.

The drive members 1808 a-d extend proximally from the end effector 1604and the wrist 1606 toward the handle 1614 (FIGS. 16 and 17 ) where theyare operatively coupled to various actuation mechanisms or devices thatfacilitate longitudinal movement (translation) of the drive members 1808a-d within the lumen 1810. Selective actuation of the drive members 1808a-d applies tension (i.e., pull force) to the given drive member 1808a-d in the proximal direction, which urges the given drive member 1808a-d to translate longitudinally within the lumen 1810.

In the illustrated embodiment, the drive members 1808 a-d each extendlongitudinally through the proximal clevis 1802 b. The distal end ofeach drive member 1808 a-d terminates at the first or second pulleys1806 a,b, thus operatively coupling each drive member 1808 a-d to theend effector 1604. In some embodiments, the distal ends of the first andsecond drive members 1808 a,b may be coupled to each other and terminateat the first pulley 1806 a, and the distal ends of the third and fourthdrive members 1808 c,d may be coupled to each other and terminate at thesecond pulley 1806 b. In at least one embodiment, the distal ends of thefirst and second drive members 1808 a,b and the distal ends of the thirdand fourth drive members 1808 c,d may each be coupled together atcorresponding ball crimps (not shown) mounted to the first and secondpulley 1806 a,b, respectively.

In at least one embodiment, the drive members 1808 a-d may operate“antagonistically”. More specifically, when the first drive member 1808a is actuated (moved), the second drive member 1808 b naturally followsas coupled to the first drive member 1808 a, and when the third drivemember 1808 c is actuated, the fourth drive member 1808 d naturallyfollows as coupled to the third drive member 1808 c, and vice versa.Antagonistic operation of the drive members 1808 a-d can open or closethe jaws 1610, 1612 and can further cause the end effector 1604 toarticulate at the wrist 1606. More specifically, selective actuation ofthe drive members 1808 a-d in known configurations or coordination cancause the end effector 1604 to articulate about one or both of the pivotaxes P₁, P₂, thus facilitating articulation of the end effector 1604 inboth pitch and yaw directions. Moreover, selective actuation of thedrive members 1808 a-d in other known configurations or coordinationwill cause the jaws 1610, 1612 to open or close. Antagonistic operationof the drive members 1808 a-d advantageously reduces the number ofcables required to provide full wrist 1606 motion, and also helpseliminate slack in the drive members 1808 a-d, which results in moreprecise motion of the end effector 1604.

In the illustrated embodiment, the end effector 1604 is able toarticulate (move) in pitch about the second or “pitch” pivot axis P₂,which is located near the distal end of the wrist 1606. Thus, the jaws1610, 1612 open and close in the direction of pitch. In otherembodiments, however, the wrist 1606 may alternatively be configuredsuch that the second pivot axis P₂ facilitates yaw articulation of thejaws 1610, 1612, without departing from the scope of the disclosure.

In some embodiments, an electrical conductor 1812 may also extendlongitudinally within the lumen 1810, through the wrist 1606, andterminate at an electrode 1814 to supply electrical energy to the endeffector 1604. In some embodiments, the electrical conductor 1812 maycomprise a wire, but may alternatively comprise a rigid or semi-rigidshaft, rod, or strip (ribbon) made of a conductive material. Theelectrical conductor 1812 may be entirely or partially covered with aninsulative covering (overmold) made of a non-conductive material. Usingthe electrical conductor 1812 and the electrode 1814, the end effector1604 may be configured for monopolar or bipolar RF operation.

In the illustrated embodiment, the end effector 1604 comprises acombination tissue grasper and vessel sealer that includes a knife (notshown), alternately referred to as a “cutting element” or “blade.” Theknife is aligned with and configured to traverse the guide track 1616(FIG. 16 ) defined longitudinally in one or both of the upper and lowerjaws 1610, 1612. The knife may be operatively coupled to the distal endof a drive rod 1816 that extends longitudinally within the lumen 1810and passes through the wrist 1606. Longitudinal movement (translation)of the drive rod 1816 correspondingly moves the knife within the guidetrack(s) 1616. Similar to the drive members 1808 a-d, the drive rod 1816may form part of the actuation systems housed within the handle 1614(FIGS. 16 and 17 ). Selective actuation of a corresponding drive inputwill cause the drive rod 1816 to move distally or proximally within thelumen 1810, and correspondingly move the knife 1816 in the samelongitudinal direction.

FIGS. 19A and 19B are isometric, partially exploded views of the endeffector 1604 of FIG. 18 , as taken from right and left vantage points,respectively. FIGS. 19A-19B depict the distal clevis 1802 a and thelinkage 1804 exploded laterally from the remaining portions of the endeffector 1604 and the wrist 1606, thus exposing the distal ends of thedrive members 1808 a-d terminating at the pulleys 1806 a,b.

In some embodiments, as illustrated, one or both of the distal clevis1802 a and the linkage 1804 may comprise two or more component partsthat are joined to help form the wrist 1606 and rotatably secure thejaws 1610, 1612 to the wrist 1606. In the illustrated embodiment, forexample, the linkage 1804 comprises opposing first and second linkageportions 1902 a,b, and the distal clevis 1802 a comprises opposing firstand second distal clevis portions 1904 a,b. In building the wrist 1606,joining the linkage portions 1902 a,b and joining the distal clevisportions 1904 a,b may help rotatably secure the jaws 1610, 1612 to thewrist 1606 and may further secure the pulleys 1806 a,b and othercomponent parts within the wrist 1606. The linkage portions 1902 a,b andthe distal clevis portions 1904 a,b may be joined, respectively, bywelding, soldering, brazing, an adhesive, an interference fit, or byusing one or more mechanical fasteners, such as pins, rivets, screws,bolts, or any combination of the foregoing. In other embodiments,however, it is contemplated herein that one or both of the distal clevis1802 a and the linkage 1804 may alternatively comprise a monolithic,one-piece structure, without departing from the scope of the disclosure.

As indicated above, the first and second pulleys 1806 a,b may berotatably mounted to the distal end of the distal clevis 1802 a at thesecond pivot axis P₂ of the wrist 1602. As illustrated, the distalclevis 1802 a may provide or otherwise define opposing pins 1910 and thepulleys 1806 a,b may each define an aperture 1912 sized to receive ormate with a corresponding one of the pins 1910. In alternativeembodiments, however, the pins 1910 may be provided by the pulleys 1806a,b, and the apertures 1912 may be provided by the distal clevis 1802 a,without departing from the scope of the disclosure. Moreover, in someembodiments, the apertures 1912 need not be through-holes, as depicted,but could alternatively comprise recesses or pockets defined in thepulleys 1806 a,b (or the distal clevis 1802 a) and sized and otherwiseconfigured to receive the pins 1910.

As also indicated above, the linkage 1804 may be mounted or otherwiseoperatively coupled to the jaws 1610, 1612. As illustrated, the linkage1804 may provide or define one or more lateral arms 1914 and the jaws1610, 1612 may define a corresponding one or more grooves 1916configured to receive the lateral arms 1914 and provide correspondinginner jaw pivot surfaces for the jaws 1610, 1612. In the illustratedembodiment, one lateral arm 1914 is received within the groove 1916defined by the first jaw 1610, and the other lateral arm 1914 isreceived within the groove 1916 defined by the second jaw 1612.Receiving the lateral arms 1914 in the grooves 1916 creates a jaw pivotpoint where the jaws 1610, 1612 are able to pivot between the open andclosed positions. The lateral arms 1914 interact with the correspondinggrooves 1916 and help prevent the jaws 1610, 1612 from separating fromeach other. In some embodiments, the lateral arms 1914 slidably engagethe corresponding grooves 1916 as the jaws 1610, 1612 open and closeabout the jaw pivot point, thus the grooves 1916 may operate ascorresponding cam surfaces. The jaw pivot points created by interactionbetween the lateral arms 1914 and the grooves 1916 may be substantiallyparallel to the second pivot axis P₂.

The wrist 1606 may further provide a jaw constraint that prevents thejaws 1610, 1612 from rotating out of alignment with each other as thejaws 1610, 1612 open and close, and may also help prevent the jaws 1610,1612 from inadvertently moving in pitch while opening or closing. In theillustrated embodiment, the jaw constraint includes one or morealignment arms, shown as a first alignment arm 1918 a (FIG. 19A) and asecond alignment arm 1918 b (FIG. 19B). The proximal end of the firstalignment arm 1918 a may be rotatably coupled (e.g., pinned) to thefirst pulley 1806 a at the second pivot axis P₂, and the proximal end ofthe second alignment arm 1918 b may be rotatably coupled (e.g., pinned)to the second pulley 1806 b at the second pivot axis P₂. In contrast,the distal end of the first alignment arm 1918 a may be received withina first slot 1920 a (FIG. 19B) defined in the first linkage portion 1902a of the linkage 1804, and the distal end of the second alignment arm1918 b may be received within a second slot 1920 b (FIG. 19A) defined inthe second linkage portion 1902 b of the linkage 1804. The slots 1920a,b extend distally and proximally such that the direction or axis ofthe slots 1920 a,b is generally parallel to a longitudinal axis A₂ ofthe end effector 1604. When the end effector 1604 is in an unarticulatedposition, the longitudinal axis A₂ and the longitudinal axis A₁ (FIG. 16) of the shaft 1602 (FIG. 16 ) are the same and otherwise concentric.

Without the jaw constraint provided by the alignment arms 1918 a,b andthe corresponding slots 1920 a,b, the jaws 1610, 1612 would tend torotate out of alignment and potentially move in pitch during opening andclosing, thus preventing accurate positioning during opening andclosing. This jaw condition is sometimes referred to as extreme backlashor slop. While two alignment arms 1918 a,b are included in theillustrated embodiments, only one alignment arm 1918 a,b may be requiredfor the purposes of the present disclosure.

FIGS. 20A and 20B are additional isometric, partially exploded views ofthe end effector 1604 of FIG. 18 from the right and left vantage points,respectively. In FIGS. 20A-20B, the distal and proximal clevises 1802a,b (FIGS. 19A-19B) are omitted for simplicity, and the first and secondpulleys 1806 a,b and the drive members 1808 a-d are shown explodedlaterally from the remaining portions of the end effector 1604 and thewrist 1606.

As illustrated, the first jaw 1610 provides a first jaw extension 2002 a(FIG. 20A) and the second jaw 1612 provides a second jaw extension 2002b (FIG. 20B), and each jaw extension 2002 a,b extends proximally fromthe corresponding jaw 1610, 1612. The first jaw extension 2002 a may berotatably coupled (e.g., pinned) to the first pulley 1806 a such thatmovement (rotation) of the first pulley 1806 a correspondingly moves thefirst jaw 1610 to pivot about the jaw pivot point, and the second jawextension 2002 b may be rotatably coupled (e.g. pinned) to the secondpulley 1806 b such that movement (rotation) of the second pulley 1806 bcorrespondingly moves the second jaw 1612 to pivot about the jaw pivotpoint.

In the illustrated embodiment, the first pulley 1806 a may provide ordefine a first jaw pin 2004 a (FIG. 20B) configured to mate with a firstjaw aperture 2006 a (FIG. 20A) defined on the first jaw extension 2002a, and the second pulley 1806 b may provide or define a second jaw pin2004 b (FIG. 20A) configured to mate with a second jaw aperture 2006 b(FIG. 20B) defined on the second jaw extension 2002 b. The first andsecond jaw pins 2004 a,b are eccentric to the second pivot axis P₂.Consequently, mating the first and second jaw pins 2004 a,b with thefirst and second jaw apertures 2006 a,b, respectively, allows thepulleys 1806 a,b to rotate about the second pivot axis P₂ to pivot thejaws 1610, 1612 about the jaw pivot points and between the open andclosed positions, as constrained by the lateral arms 1914 (FIGS.19A-19B).

In an alternative embodiment, the first and second jaw pins 2004 a,b maybe provided on the first and second jaw extensions 2002 a,b,respectively, and the first and second jaw apertures 2006 a,b may beprovided on the pulleys 1806 a,b, respectively, or any combinationthereof. Moreover, the jaw apertures 2006 a,b need not be through-holes,as depicted, but could alternatively comprise recesses defined in thejaw extensions 2002 a,b (or the pulleys 1806 a,b) and sized andotherwise configured to receive the jaw pins 2004 a,b.

As mentioned above, the first and second alignment arms 1918 a,b may berotatably coupled (e.g., pinned) to the first and second pulleys 1806a,b, respectively, at the second pivot axis P₂. In the illustratedembodiment, for example, the first pulley 1806 a may provide or define afirst arm pin 2008 a (FIG. 20B) configured to mate with a first armaperture 2010 a defined by the first alignment arm 1918 a, and thesecond pulley 1806 b may provide or define a second arm pin 2008 b (FIG.20A) configured to mate with a second arm aperture 2010 b (FIG. 20B)defined by the second alignment arm 1918 b (FIG. 20B). The first andsecond arm pins 2008 a,b are concentric to (with) the second pivot axisP₂, thus allowing the pulleys 1806 a,b to rotate without directlyaffecting the position of the alignment arms 1918 a,b. However,actuation of the pulleys 1806 a,b to open and close the jaws 1610, 1612may result in the distal ends of the alignment arms 1918 a,b sliding(traversing) within the corresponding slots 1920 a,b (FIGS. 19A-19B),respectively. This helps maintain the jaws 1610, 1612 moving distallyand/or proximally in a straight line during closing and opening (i.e.,axial constraint), instead of rotating about the jaw pins 2004 a,b.

In an alternative embodiment, the first and second arm pins 2008 a,b maybe provided on the alignment arms 1918 a,b, respectively, and the firstand second arm apertures 2010 a,b may be provided on the pulleys 1806a,b, respectively, or any combination thereof, without departing fromthe scope of the disclosure. Moreover, the arm apertures 2010 a,b neednot be through-holes, as depicted, but could alternatively compriserecesses defined in the alignment arms 1918 a,b (or the pulleys 1806a,b) and sized and otherwise configured to receive the arm pins 2008a,b.

As indicated above, selective actuation and antagonistic operation ofthe drive members 1808 a-d can open or close the jaws 1610, 1612.Because the jaws 1610, 1612 are pinned to the pulleys 1806 a,b andpivotally constrained at the jaw pivot points by the lateral arms 1914(FIGS. 19A-19B) at the grooves 1916, as generally described above,selectively actuating the drive members 1808 a-d such that the pulleys1806 a,b rotate in opposite angular directions may result in the jaws1610, 1612 opening or closing. Simultaneously pulling proximally on thefirst and fourth drive members 1808 a,d, for example, while allowing thesecond and third drive members 1808 b,c to pay out slack, will cause thepulleys 1806 a,b to rotate in first opposing directions and therebycause the jaws 1610, 1612 to move (pivot) toward the closed position. Incontrast, simultaneously pulling proximally on the second and thirddrive members 1808 b,c while allowing the first and fourth drive members1808 a,d to pay out slack, will cause the pulleys 1806 a,b to rotate insecond opposing directions opposite the first opposing directions andthereby cause the jaws 1610, 1612 to move (pivot) toward the openposition.

As also indicated above, selective actuation and antagonistic operationof the drive members 1808 a-d may also cause the end effector 1604 toarticulate at the wrist 1606 in both pitch and yaw directions. Again,because the jaws 1610, 1612 are pinned to the pulleys 1806 a,b andpivotally constrained at the jaw pivot point by the lateral arms 1914(FIGS. 19A-19B) at the grooves 1916, selectively actuating the drivemembers 1808 a-d such that the pulleys 1806 a,b rotate in the sameangular direction may result in the jaws 1610, 1612 pivoting about thesecond pivot axis P₂ and thereby moving the end effector 1604 up or downin pitch. More specifically, simultaneously pulling on the first andthird drive members 1808 a,c while allowing the second and fourth drivemembers 1808 b,d to pay out slack will cause the pulleys 1808 a,b torotate in a first angular direction and thereby pivot the end effector1604 about the second pivot axis P₂ in upward pitch. In contrast,simultaneously pulling on the second and fourth drive members 1808 b,dwhile allowing the first and third drive members 1808 a,c to pay outwill cause the pulleys 1808 a,b to rotate in a second angular directionopposite the first angular direction and thereby pivot the end effector1604 about the second pivot axis P₂ in downward pitch.

Furthermore, selective actuation of a first connected pair of drivemembers 1808 a-d while relaxing a second pair of connected drive members1808 a-d may cause the end effector 1604 to pivot about the rollingjoint P₁ (FIG. 18 ) and thereby move in yaw. More specifically, pullingon the first and second drive members 1808 a,b while simultaneouslyslackening the third and fourth drive members 1808 c,d (e.g., allowingthe third and fourth drive members 1808 c,d to pay out) will pivot theend effector 1604 in yaw in a first direction. In contrast, pulling onthe third and fourth drive members 1808 c,d while simultaneouslyslackening the first and second drive members 1808 a,b (e.g., allowingthe first and second drive members 1808 a,b to pay out) will pivot theend effector 1604 in yaw in a second direction opposite the firstdirection.

FIGS. 21A and 21B are additional isometric, partially exploded views ofthe end effector 1604 of FIG. 18 from the right and left vantage points,respectively. In FIGS. 21A-21B, the distal clevis 1802 a, the linkage1804 (FIGS. 19A-19B), the drive members 1808 a-d (FIGS. 20A-20B), thepulleys 1806 a,b (FIGS. 20A-20B), and the first or “upper” jaw 1612 areall omitted for simplicity. The first and second alignment arms 1918 a,bare shown in FIGS. 21A-21B exploded laterally from the remainingportions of the end effector 1604 and the wrist 1606. As mentionedabove, however, only one of the alignment arms 1918 a,b need beincluded, without departing from the scope of the disclosure.

In some embodiments, as illustrated, each alignment arm 1918 a,b mayprovide or otherwise define an alignment head 2102 configured orotherwise sized to be received within the corresponding and adjacentslot 1920 a,b (FIGS. 19A-19B) defined in the linkage 1804 (FIGS.19A-19B). The alignment head 2102 may be provided at or near the distalend of each alignment arm 1918 a,b, or may otherwise be arranged at anylocation along the alignment arm 1918 a,b and distal to the armapertures 2010 a,b.

In the illustrated embodiment, the wrist 1606 may further include adistal wedge 2104 and a mid-articulation insert 2106 arranged in seriesand positioned in the central portion or middle of the wrist 1606. Thedistal wedge 2104 may be arranged between the electrode 1814 and thedistal clevis 1802 a (FIGS. 19A-19B) and generally arranged within thelinkage 1804 (FIGS. 18 and 19A-19B), and the mid-articulation insert2106 may be generally arranged within the distal clevis 1802 a (FIGS. 18and 19A-19B). The distal wedge 2104 and the mid-articulation insert 2106may be positioned between (interpose) the first and second jawextensions 2002 a,b of the jaws 1610, 1612 (only the first jaw extension2002 a of the lower jaw 1610 depicted in FIGS. 21A-21B). The distalwedge 2104 and mid-articulation insert 2106 may act to guide the jawextensions 2002 a,b in planar rotation as the jaws 1610, 1612 open,close, and articulate in pitch.

The distal wedge 2104 may be made of a variety of rigid materialsincluding, but not limited to, a metal, a cast metal alloy, a wroughtmetal, a polymer composite, a ceramic, a negative-index metamaterial(NIM), a metal injection molding (MIM), a reinforced plastic orthermoplastic, (e.g., nylon, polyetherimide or Ultem®, polyether etherketone or PEEK, etc.), or any combination thereof. In some embodiments,the reinforced plastics or thermoplastics may be carbon or glass filled.

In some embodiments, the distal wedge 2104 may receive and help guidethe knife (not shown) to the jaws 1610, 1612. More specifically, thedistal wedge 2104 may define a knife cavity (not shown) through whichthe knife and the drive rod 1818 are able to extend to move the knifeinto and along the guide track 1616. Upon firing the end effector 1604,the drive rod 1818 is moved (urged) distally, which correspondinglymoves the knife out of the distal wedge 2104 and into the guide track1616. After firing is complete, the drive rod 1818 is retractedproximally, which pulls the knife proximally and back into distal wedge2104 until it is desired to again fire the end effector 1604.

In some embodiments, the distal wedge 2104 may also receive and helpguide the electrical conductor 1812 to the jaws 1610, 1612 and, moreparticularly, to the electrode 1814 to provide an electrical currentgenerated by at least one electrosurgical generator in electricalcommunication with the handle 1614 (FIGS. 16 and 17 ). The distal wedge2104 may also be configured to protect the electrical conductor 1812from damage and manage slack in the electrical conductor 1812 while theend effector 1604 and the wrist 1606 to operate. More specifically, thedistal wedge 2104 may be designed to guide the electrical conductor 1812to ensure that it is isolated from moving parts and/or mechanisms of theend effector 1604 or the wrist 1606, which may inadvertently abrade ordamage the electrical conductor 1812 and thereby potentially result inarcing or shorting. Example moving parts and/or mechanisms of the endeffector 1604 or the wrist 1606 include the knife rod 1818, the clevises1802 a,b, and the articulation arms 1918 a,b, all of which couldinadvertently contact and damage the electrical conductor 1812 duringoperation if not properly protected by the distal wedge 2104.

To guide and protect the electrical conductor 1812 from damage, thedistal wedge 2104 may provide or otherwise define one or more conductorconduits 2108 (one visible in FIG. 21A) configured to receive and guidethe electrical conductor 1812 to the electrode 1814. The conductorconduit(s) 2108 may pass through, around, above, below, or on one orboth sides of the distal wedge 2104, or any combination thereof. In someembodiments, the conductor conduit 2108 may define or otherwise provideone or more vertical and/or horizontal curves, undulations, or directionchanges that alter the course or pathway of the conductor conduit 2108and thereby change the course of the electrical conductor 1812 receivedwithin the conductor conduit 2108.

The distal wedge 2104 may further provide or otherwise define one ormore arcuate surfaces, shown as a first or “upper” arcuate surface 2110a and a second or “lower” arcuate surface 2110 b (not visible in FIGS.21A-21B). As illustrated, the arcuate surfaces 2110 a,b may compriseconcave surfaces, and may be configured to receive and engagecorresponding curved (convex) portions of the jaws 1610, 1612. Asdescribed in more detail below, the arcuate surfaces 2110 a,b mayoperate as camming surfaces for the jaws 1610, 1612 as they open andclose.

In some embodiments, as illustrated, a channel 2112 (FIG. 21B) may beprovided or otherwise defined on one or both lateral sides of the distalwedge 2104 and may be configured to receive and slidably mate with acorresponding projection 2114 provided by an adjacent alignment arm 1918a,b. In the illustrated embodiment, the channel 2112 is provided on onlyone lateral side of the distal wedge 2104 and is configured to receiveand slidably mate with a projection 2114 provided by the secondalignment arm 1918 b. In other embodiments, however, channels 2112 couldalternatively be provided on both lateral sides of the distal wedge 2104and configured to mate with adjacent projections 2114 provided by eachalignment arm 1918 a,b, without departing from the scope of thedisclosure.

As illustrated, the projection 2114 may be provided on one lateral sideof the alignment arm 1918 b to slidably mate with the channel 2112,while the alignment head 2102 may be provided on the opposing lateralside of the alignment arm 1918 b to slidably mate with the second slot1920 b (FIG. 19A). In some embodiments, the channel 2112 may extenddistally and proximally such that the direction or axis of the channel2112 is generally parallel to the longitudinal axis A₂ (FIGS. 19A-19B)of the end effector 1604. In other embodiments, however, the channel2112 may be arcuate or otherwise non-straight, without departing fromthe scope of the disclosure. In such embodiments, for example, bothalignment arms 1918 a,b may be used with pin-in-slot arrangements oneach side. Depending on the specifics of the arrangement, a coupledmotion between jaw closure and pitch cold be achieved, and this type ofcoupling could result in a predefined end effector rotation during jawclosure, coupled with robotic arm motion can create the user perceivedeffect of the bottom jaw remaining stationary against tissue while thetop jaw completes the clamping motion. As discussed in more detailbelow, slidably mating the projection 2114 within the channel 2112 mayhelp rotationally constrain the distal wedge 2104 to the alignment arm1918 b, which may help reduce backlash in the jaws 1610, 1612.

While FIGS. 21A-21B depict the channel 2112 as being provided on thedistal wedge 2104 and the projection 2114 as being provided on thealignment arm 1918 b, the component features may be switched, withoutdeparting from the scope of the disclosure. More specifically, it iscontemplated herein that the channel 2112 may alternatively be providedon the alignment arm 1918 b and the projection 2114 may alternatively beprovided on the distal wedge 2104.

FIG. 22 is an enlarged, partial cross-sectional side view of the endeffector 1604, according to one or more embodiments. As mentioned above,the distal wedge 2104 may provide upper and lower arcuate (concave)surfaces 2110 a,b configured to receive and engage corresponding curved(convex) portions of the jaws 1610, 1612. More specifically, the upperjaw 1612 may provide or define a first or “upper” journal 2202 aconfigured to engage the upper arcuate surface 2110 a, and the lower jaw1610 may provide or define a second or “lower” journal 2202 b configuredto engage the lower arcuate surface 2110 b. Engagement between theopposing arcuate surfaces 2110 a,b and journals 2202 a,b, respectively,provides or facilitates the jaw pivot point discussed herein, where thejaws 1610, 1612 pivot between open and closed positions. As the jaws1610, 1612 move between the open and closed positions, the opposingarcuate surfaces 2110 a,b and journals 2202 a,b act in slidingengagement as opposing camming surfaces.

The arcuate surfaces 2110 a,b of the distal wedge 2104 may proveadvantageous in touch and spread dissection operations, where a useropens the jaws 1610, 1612 to move tissue. In such operations, a load isapplied on the top or bottom of the jaws 1610, 1612 and this load istransferred to the distal wedge 2104 at the corresponding arcuatesurface 2110 a,b. Furthermore, the distal wedge 2104 acts between thejaws 1610, 1612 during spread dissection, where the jaws 1610, 1612 areplaced between tissue planes or through an aperture in tissue, and thenopened to separate tissue and such loads are transferred to the arcuatesurfaces 2110 a,b and borne by the distal wedge 2104. Accordingly, thearcuate surfaces 2110 a,b help support the jaws 1610, 1612 and bearloading forces that are required to move or spread tissue.

The jaws 1610, 1612 are depicted in FIG. 22 in an open position. When inthis orientation and brought into contact with an adjacent structureduring operation (e.g., a vessel, an organ, tissue, etc.), the jaws1610, 1612 will oftentimes move (shift) until clearance betweenstructural components of the end effector 1604 is taken up and the endeffector 1604 eventually stiffens. The effect of such clearance betweenadjacent structural components of the end effector 1604 manifests as alack of jaw stiffness, which is often referred to as jaw backlash. Thoseskilled in the art will readily appreciate that jaw backlash can reducethe effectiveness of surgical tasks, such as blunt dissection and otomycreation in tissue.

One prevalent cause of jaw backlash results as the distal wedge 2104moves, shifts, or rotates when acted upon by movement of the jaws 1610,1612 at the upper and lower journals 2202 a,b. To the extent permittedby component clearances, the jaws 1610, 1612 can shear distal toproximal as the distal wedge 2104 rotates or shifts beneath forcestransferred from the journals 2202 a,b. This jaw motion allows play orbacklash to occur in the pitch axis until clearances are taken up. Asdescribed here “shearing” is the term given to the top jaw translatingdistally in the direction of the shaft axis, while the lower jawsimultaneously translates proximally, and vise versa. This jaw motionallows play or backlash to occur in the pitch axis until clearances aretaken up. According to embodiments of the present disclosure, thesliding and mated engagement between the projection 2114 (FIGS. 21A-21B)and the channel 2112 (FIGS. 21A-21B) provided on the distal wedge 2104may help stabilize and rotationally constrain the distal wedge 2104,which may help reduce resulting backlash in the jaws 1610, 1612.

FIG. 23 is another enlarged, partial cross-sectional side view of theend effector 1604, according to one or more embodiments. As illustrated,the projection 2114 provided by the second alignment arm 1918 b isreceived within the channel 2112 defined or otherwise provided on thelateral side of the distal wedge 2104. Slidably receiving the projection2114 within the channel 2112 helps to rotationally constrain the distalwedge 2104 to the alignment arm 1918 b, and, as discussed above, thealignment arm 1918 a is configured to translate within the slot 1920 bdefined in the linkage 1804. Consequently, receiving the projection 2114within the channel 2112 effectively constrains the distal wedge 2104 tothe linkage 1804, and thereby limits unwanted jaw rotation with respectto the distal articulation joint; i.e., reduction in jaw backlash.

In some embodiments, the structure that helps define the channel 2112may further provide or otherwise define an upper surface 2302 engageablewith a portion of the upper jaw 1612. As illustrated, the upper surface2302 may be ramped, angled, or otherwise arcuate to help support theupper jaw 1612 and further provide clearance for the upper jaw 1612 tomove between the open and closed positions.

Embodiments disclosed herein include:

-   A. A robotic surgical tool includes an elongate shaft, an end    effector arranged at a distal end of the shaft and including    opposing first and second jaws, and an articulable wrist interposing    the end effector and the distal end of the shaft, the wrist    including a linkage mounted to the first and second jaws and    defining a slot, a distal wedge arranged at least partially within    the linkage, an alignment arm interposing the linkage and the distal    wedge and providing an alignment head receivable within the slot, a    channel provided on one of the distal wedge or the alignment arm,    and a projection provided on the other of the distal wedge or the    alignment arm and receivable within the channel, wherein the    alignment head is translatable within the slot and the projection is    translatable within the channel during operation of the end    effector.-   B. An end effector for a robotic surgical tool includes opposing    first and second jaws, and an articulable wrist operatively coupled    to the first and second jaws and including a linkage mounted to the    first and second jaws and defining a slot, a distal wedge arranged    at least partially within the linkage, an alignment arm interposing    the linkage and the distal wedge and providing an alignment head    receivable within the slot, a channel provided on one of the distal    wedge or the alignment arm, and a projection provided on the other    of the distal wedge or the alignment arm and receivable within the    channel, wherein the alignment head is translatable within the slot    and the projection is translatable within the channel during    operation of the end effector.-   C. A method of operating a robotic surgical tool includes locating a    robotic surgical tool adjacent a patient, the robotic surgical tool    having an elongate shaft, an end effector arranged at a distal end    of the shaft and including opposing first and second jaws, and an    articulable wrist that interposes the end effector and the distal    end, the wrist including, a linkage mounted to the first and second    jaws and defining a slot, a distal wedge arranged at least partially    within the linkage, an alignment arm interposing the linkage and the    distal wedge and providing an alignment head receivable within the    slot, a channel provided on one of the distal wedge or the alignment    arm, and a projection provided on the other of the distal wedge or    the alignment arm and receivable within the channel. The method    further including operating the end effector or the wrist,    stabilizing the distal wedge with the projection received within the    channel as the end effector or the wrist operate, and reducing    backlash in the end effector with the alignment head received within    the slot as the end effector or the wrist operate.

Each of embodiments A, B, and C may have one or more of the followingadditional elements in any combination: Element 1: wherein the first jawprovides a first jaw extension and the second jaw provides a second jawextension, the articulable wrist further including a distal clevis, andfirst and second pulleys rotatably mounted to the distal clevis at apivot axis, the first jaw extension being pinned to the first pulley andthe second jaw extension being pinned to the second pulley, wherein thealignment arm is rotatably mounted to the first pulley at the pivotaxis. Element 2: wherein the distal wedge is positioned between thefirst and second jaw extensions. Element 3: wherein the distal wedgedefines upper and lower arcuate surfaces engageable with upper and lowerjournals, respectively, provided by the first and second jaws. Element4: wherein the first and second jaw extensions are pinned to the firstand second pulleys, respectively, eccentric to the pivot axis. Element5: further comprising an electrical conductor extending through thewrist and to an electrode located at the end effector, wherein thedistal wedge guides the electrical conductor to the electrode. Element6: further comprising a knife rod extendable through the central portionof the wrist and terminating at a knife, the knife rod and the knifebeing translatable through the distal wedge. Element 7: wherein the slotis a first slot, the alignment arm is a first alignment arm, and thealignment head is a first alignment head, the articulable wrist furtherincluding a second alignment arm rotatably mounted to the second pulleyat the pivot axis and providing a second alignment head translatablewithin a second slot defined in the linkage, wherein the second slotextends parallel to a longitudinal axis of the end effector. Element 8:further comprising a handle through which the shaft is extendable, thehandle being matable with an instrument driver arranged at an end of arobotic arm, and a plurality of drive members extending along the shaftand terminating at the first and second pulleys, wherein the pluralityof drive members are antagonistically operable via the handle to openand close the first and second jaws and articulate the end effector inpitch and yaw. Element 9: wherein the end effector is selected from thegroup consisting of a surgical stapler, a tissue grasper, surgicalscissors, an advanced energy vessel sealer, a clip applier, a needledriver, a babcock including a pair of opposed grasping jaws, bipolarjaws, and any combination thereof.

Element 10: wherein the first jaw provides a first jaw extension and thesecond jaw provides a second jaw extension, the articulable wristfurther including a distal clevis, and first and second pulleysrotatably mounted to the distal clevis at a pivot axis, the first jawextension being pinned to the first pulley and the second jaw extensionbeing pinned to the second pulley, wherein the alignment arm isrotatably mounted to the first pulley at the pivot axis. Element 11:wherein the distal wedge is positioned between the first and second jawextensions. Element 12: wherein the distal wedge defines upper and lowerarcuate surfaces engageable with upper and lower journals, respectively,provided by the first and second jaws. Element 13: wherein theprojection is provided on a first lateral side of the alignment arm andthe alignment head is provided on a second lateral side of the alignmentarm. Element 14: wherein the channel extends distally and proximally andparallel to a longitudinal axis of the end effector. Element 15: whereinthe channel defines a ramped upper surface engageable with a portion ofthe first jaw.

Element 16: wherein the channel extends parallel to a longitudinal axisof the end effector, and wherein stabilizing the distal wedge with theprojection received within the channel comprises translating theprojection within the channel as the first and second jaws open andclose. Element 17: wherein the first jaw provides a first jaw extension,the second jaw provides a second jaw extension, and the articulablewrist further includes a distal clevis and first and second pulleysrotatably mounted to the distal clevis at a pivot axis, the first jawextension being pinned to the first pulley, the second jaw extensionbeing pinned to the second pulley, and the alignment arm being rotatablymounted to the first pulley at the pivot axis, the method furthercomprising, actuating the first and second pulleys to open or close thefirst and second jaws, and preventing the first and second jaws fromrotating in pitch or out of alignment with each other with the alignmenthead received within the slot.

By way of non-limiting example, exemplary combinations applicable to A,B, and C include: Element 1 with Element 2; and Element 10 with Element11.

Implementing Systems and Terminology

Implementations disclosed herein provide systems, methods and apparatusfor instruments for use with robotic systems. It should be noted thatthe terms “couple,” “coupling,” “coupled” or other variations of theword couple as used herein may indicate either an indirect connection ora direct connection. For example, if a first component is “coupled” to asecond component, the first component may be either indirectly connectedto the second component via another component or directly connected tothe second component.

The methods disclosed herein comprise one or more steps or actions forachieving the described method. The method steps and/or actions may beinterchanged with one another without departing from the scope of theclaims. In other words, unless a specific order of steps or actions isrequired for proper operation of the method that is being described, theorder and/or use of specific steps and/or actions may be modifiedwithout departing from the scope of the claims.

As used herein, the term “plurality” denotes two or more. For example, aplurality of components indicates two or more components. The term“determining” encompasses a wide variety of actions and, therefore,“determining” can include calculating, computing, processing, deriving,investigating, looking up (e.g., looking up in a table, a database oranother data structure), ascertaining and the like. Also, “determining”can include receiving (e.g., receiving information), accessing (e.g.,accessing data in a memory) and the like. Also, “determining” caninclude resolving, selecting, choosing, establishing and the like.

The phrase “based on” does not mean “based only on,” unless expresslyspecified otherwise. In other words, the phrase “based on” describesboth “based only on” and “based at least on.”

As used herein, the terms “generally” and “substantially” are intendedto encompass structural or numeral modification which do notsignificantly affect the purpose of the element or number modified bysuch term.

To aid the Patent Office and any readers of this application and anyresulting patent in interpreting the claims appended herein, applicantsdo not intend any of the appended claims or claim elements to invoke 35U.S.C. 112(f) unless the words “means for” or “step for” are explicitlyused in the particular claim.

The foregoing previous description of the disclosed implementations isprovided to enable any person skilled in the art to make or use thepresent invention. Various modifications to these implementations willbe readily apparent to those skilled in the art, and the genericprinciples defined herein may be applied to other implementationswithout departing from the scope of the invention. For example, it willbe appreciated that one of ordinary skill in the art will be able toemploy a number corresponding alternative and equivalent structuraldetails, such as equivalent ways of fastening, mounting, coupling, orengaging tool components, equivalent mechanisms for producing particularactuation motions, and equivalent mechanisms for delivering electricalenergy. Thus, the present invention is not intended to be limited to theimplementations shown herein but is to be accorded the widest scopeconsistent with the principles and novel features disclosed herein.

What is claimed is:
 1. A robotic surgical tool, comprising: an elongateshaft; an end effector arranged at a distal end of the shaft andincluding opposing first and second jaws; and an articulable wristinterposing the end effector and the distal end of the shaft, the wristincluding: a linkage mounted to the first and second jaws and defining aslot; a distal wedge arranged at least partially within the linkage; analignment arm interposing the linkage and the distal wedge and providingan alignment head receivable within the slot; a channel provided on oneof the distal wedge or the alignment arm; and a projection provided onthe other of the distal wedge or the alignment arm and receivable withinthe channel, wherein the alignment head is translatable within the slotand the projection is translatable within the channel during operationof the end effector.
 2. The robotic surgical tool of claim 1, whereinthe first jaw provides a first jaw extension and the second jaw providesa second jaw extension, the articulable wrist further including: adistal clevis; and first and second pulleys rotatably mounted to thedistal clevis at a pivot axis, the first jaw extension being pinned tothe first pulley and the second jaw extension being pinned to the secondpulley, wherein the alignment arm is rotatably mounted to the firstpulley at the pivot axis.
 3. The robotic surgical tool of claim 2,wherein the distal wedge is positioned between the first and second jawextensions.
 4. The robotic surgical tool of claim 1, wherein the distalwedge defines upper and lower arcuate surfaces engageable with upper andlower journals, respectively, provided by the first and second jaws. 5.The robotic surgical tool of claim 1, wherein the first and second jawextensions are pinned to the first and second pulleys, respectively,eccentric to the pivot axis.
 6. The robotic surgical tool of claim 1,further comprising an electrical conductor extending through the wristand to an electrode located at the end effector, wherein the distalwedge guides the electrical conductor to the electrode.
 7. The roboticsurgical tool of claim 1, further comprising a knife rod extendablethrough the central portion of the wrist and terminating at a knife, theknife rod and the knife being translatable through the distal wedge. 8.The robotic surgical tool of claim 1, wherein the slot is a first slot,the alignment arm is a first alignment arm, and the alignment head is afirst alignment head, the articulable wrist further including: a secondalignment arm rotatably mounted to the second pulley at the pivot axisand providing a second alignment head translatable within a second slotdefined in the linkage, wherein the second slot extends parallel to alongitudinal axis of the end effector.
 9. The robotic surgical tool ofclaim 1, further comprising: a handle through which the shaft isextendable, the handle being matable with an instrument driver arrangedat an end of a robotic arm; and a plurality of drive members extendingalong the shaft and terminating at the first and second pulleys, whereinthe plurality of drive members are antagonistically operable via thehandle to open and close the first and second jaws and articulate theend effector in pitch and yaw.
 10. The robotic surgical tool of claim 1,wherein the end effector is selected from the group consisting of asurgical stapler, a tissue grasper, surgical scissors, an advancedenergy vessel sealer, a clip applier, a needle driver, a babcockincluding a pair of opposed grasping jaws, bipolar jaws, and anycombination thereof.
 11. An end effector for a robotic surgical tool,comprising: opposing first and second jaws; and an articulable wristoperatively coupled to the first and second jaws and including: alinkage mounted to the first and second jaws and defining a slot; adistal wedge arranged at least partially within the linkage; analignment arm interposing the linkage and the distal wedge and providingan alignment head receivable within the slot; a channel provided on oneof the distal wedge or the alignment arm; and a projection provided onthe other of the distal wedge or the alignment arm and receivable withinthe channel, wherein the alignment head is translatable within the slotand the projection is translatable within the channel during operationof the end effector.
 12. The end effector of claim 11, wherein the firstjaw provides a first jaw extension and the second jaw provides a secondjaw extension, the articulable wrist further including: a distal clevis;and first and second pulleys rotatably mounted to the distal clevis at apivot axis, the first jaw extension being pinned to the first pulley andthe second jaw extension being pinned to the second pulley, wherein thealignment arm is rotatably mounted to the first pulley at the pivotaxis.
 13. The end effector of claim 12, wherein the distal wedge ispositioned between the first and second jaw extensions.
 14. The endeffector of claim 11, wherein the distal wedge defines upper and lowerarcuate surfaces engageable with upper and lower journals, respectively,provided by the first and second jaws.
 15. The end effector of claim 11,wherein the projection is provided on a first lateral side of thealignment arm and the alignment head is provided on a second lateralside of the alignment arm.
 16. The end effector of claim 11, wherein thechannel extends distally and proximally and parallel to a longitudinalaxis of the end effector.
 17. The end effector of claim 11, wherein thechannel defines a ramped upper surface engageable with a portion of thefirst jaw.
 18. A method of operating a robotic surgical tool,comprising: locating a robotic surgical tool adjacent a patient, therobotic surgical tool having an elongate shaft, an end effector arrangedat a distal end of the shaft and including opposing first and secondjaws, and an articulable wrist that interposes the end effector and thedistal end, the wrist including: a linkage mounted to the first andsecond jaws and defining a slot; a distal wedge arranged at leastpartially within the linkage; an alignment arm interposing the linkageand the distal wedge and providing an alignment head receivable withinthe slot; a channel provided on one of the distal wedge or the alignmentarm; and a projection provided on the other of the distal wedge or thealignment arm and receivable within the channel; operating the endeffector or the wrist; stabilizing the distal wedge with the projectionreceived within the channel as the end effector or the wrist operate;and reducing backlash in the end effector with the alignment headreceived within the slot as the end effector or the wrist operate. 19.The method of claim 18, wherein the channel extends parallel to alongitudinal axis of the end effector, and wherein stabilizing thedistal wedge with the projection received within the channel comprisestranslating the projection within the channel as the first and secondjaws open and close.
 20. The method of claim 18, wherein the first jawprovides a first jaw extension, the second jaw provides a second jawextension, and the articulable wrist further includes a distal clevisand first and second pulleys rotatably mounted to the distal clevis at apivot axis, the first jaw extension being pinned to the first pulley,the second jaw extension being pinned to the second pulley, and thealignment arm being rotatably mounted to the first pulley at the pivotaxis, the method further comprising, actuating the first and secondpulleys to open or close the first and second jaws; and preventing thefirst and second jaws from rotating in pitch or out of alignment witheach other with the alignment head received within the slot.